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BULLETIN School of Medicine
University of Maryland

VOLUME 49 JANUARY, 1964 NUMBER i

TABLE OF CONTENTS

PAGE

ORIGINAL ARTICLES

The Reproductive Behavior of the Adolescent Female _ 3

Arthur L. Haskins, M.D.

A Controlled Study of Erythromycin in Acne Therapy 10

Harry M. Robinson. Jr.. M.D.

John James Audubon's Baltimore Physician Patrons „„ 14

G. E. afford. Jr.. M.D.

MEDICAL SCHOOL SECTION

Dean's Letter — .

Dean's Office Announces Promotions..

Book Reviews

Abstracts

The Laboratory Animal and New Drugs _ xi

John C. Krantz, Jr.. Ph.D., and Freichi G. Rudo

ALUMNI ASSOCIATION SECTION

President's Letter

Change of Annual Meeting Date

Dr. Hugh R. Spencer Named to Receive 1964 Award _ xviii

As We Approach Our 50th Anniversary^ _ _ xx

Alumni Hold Meeting in New Orleans _ ._ xxi

Class Notes _ _ xxii

Deaths _ xxiv

Alumni News Report ^ __.xxvii

January, 1964 1

Volume 4y

Number 1

JANUARY 1964

BULLETIN School of Medicine

University of Maryland

EDITORIAL BOARD

Chief Editor
HN A. WAGNER, B.S., M.D.

George Entwisie, B.S., M.D.

John C. Krantz, Jr., Sc.O., Ph.D.

William H. Mosberg, B.S.. M.D.

arry M. Robinson, Jr., B.S., M.D.

John E. Savage, M.D.

C. Vernon Williamson, M.D.

iiliam S. Stone, M.S.. D.Sc., M.D.
(ex>officio)

Clbson J. Weils, M.D.
Cex-officio)

Associate Editors

Otto C. Brantigan, B.S., M.D.

D. Frank Kaltreider, M.D.

Vernon E. Krahl, Ph.D.

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Manasins Editor
William J. Wiscott

The Reproductive Behavior
of the Adolescent Female

ARTHUR L. HASKINS, M.D.

Israel and Woutersz^ studied 3,995
teen-age obstetric patients as part of a
group of 40,709 parturients. A higher
incidence of pre-eclampsia, one day fever,
puerperal morbidity, and prolonged labor
was noted among the teen-agers. This
study and its findings provided the stim-
ulus for a review of the obstetrical data
at the University of Maryland Hospital
in regard to the reproductive behavior of
the female teen-ager.

The medical, physiologic, and ethnic
implications of study of the Maryland
data were considered to be of sufficient
interest to warrant publication of part of
the material and the significant conclu-
sions. Although obviously of greater local
than general interest, the experience at
the University of Maryland Hospital in
the care of gravid teen-agers might find
some universality of application to spe-
cific medical or sociologic problems else-
where.

The term adolescent, used throughout
this study, refers to the period of life
between puberty and maturity. Puberty
is defined as the state or quality of being
first capable of bearing offspring. Ma-
turity, although usually referable to com-
pleteness or cessation of growth and de-
velopment, as used herein, is the attain-
ment of tlie age of 20 years. It is appar-
ent that this material reflects more than
a teen-age experience, since tlie ability
to reproduce comes to some individuals
who have not yet reached the teen-age.

The often observed fact that racial,
cultural, or sociologic variations may re-
sult in differences in physiological and
medical behavior necessitated the divi-
sion of our material into non-white and
white groups. Had this division not been
accomplished, potential differences be-
tween adolescent reproductive behavior
and mature reproductive behavior might
have been obscured or accentuated be-
cause of factors other than age.

The material is organized so that com-
parisons may be made between the re-
productive behavior of non-white and
white, as well as adolescent and mature
parturients.

The pregnancies represented in these
studies are those which occurred at the
University Hospital from 1950 thru 1959
(Table 1). The total number of preg-
nancies were 31,495. The distribution be-
tween the white and non-white popula-
tion was approximately equal. It should
l)e noted that the non-white group of
patients are primarily clinic in origin,
whereas the w-hite patients are pre-

Table 1. Adolescent Obstetrics,
University of Maryland Hospital 1950-59

Department of Obstetrics and Gynecology, School of
Medicine, University of Maryland, Baltimore.

Total

White

Non-
White

Adolescent
Pregnancies

7,069

1,752

5,317

Adult

Pregnancies

24,426

13,266

11,160

All Pregnancies

31,495

15,018

16,477

January. l'J64

BCLLETIX OF THE SCHOOL OF MEDICINE. UNU'ERSITV OF MARVLAND

Table 2. Adolescent Obstetrics,
University of Maryland Hospital 1950-59

White

rARI
0

TY
1

Total

Age under 15

Age 15 - 19

1,304

349

1,731

Non-White

Age under 15

357

366

Age 15 - 19

3,816

826

252

4,951

dominately private. The 7,069 adolescent
pregnancies represent approximately
25 /r of the total sample. Despite the
eqnal distribution of the white and non-
white population in the total pregnancies,
the ratio of non-white to white in the
adolescent pregnancy group was approx-
imately 4-1.

The parity of the adolescents under
observation is illustrated in Table 2. It
is apparent from this tabulation that a
significant number of pregnancies oc-
curred in our population prior to the age
of 15. In addition, there was an occasion-
al patient in whom repeated pregnancy
occurred prior to the age of 15. The over-
whelming portion of this population was,
however, in the 15-19 year group.

Many factors and correlations in our
data were studied. In the final compila-
tion either because of significance or in-
terest the following items were tabulated :
prematiu-e births, perinatal mortality, ab-
normal presentations, multiple pregnan-
cy, fetal anomaly, uterine inertia, con-
tracted pelvis, prolonged labor, placenta
previa, premature separation of the
placenta, cesarean section, and toxemia
of pregnancy.

RESULTS

Prematurity. As defined in this study,
the premature infant has a birth weight

of 1 ,000 to 2,499 grams. Our experience
with premature births is tabulated in
Table 3A. Prematurity probably con-
tributes to or is responsible for approx-
imately 50% of fetal mortality during
the neonatal period. It is, therefore, the
most common cause of neonatal death.
Our prematurity rates varied from 8.8%
in the mature white mothers to 17.8%
in the adolescent non-white mothers.
These data showed two trends. There is
an increased premature birth rate in the
non- white pregnancies. In addition, there
is increased prematurity in the adoles-
cent pregnancies whether these occur in
the non-white or white population.

The usual medical factors associated
with premature labor are chronic hyper-
tension, premature separation of the
placenta, placenta previa, heart disease,
toxemia, and syphilis. In addition to
disease processes, prematurity seems to
occur with increasing frequency in those
individuals with a poor economic back-
ground and in the primigravida.

There was no evidence of an increase
in chronic hypertension, premature sep-
aration of the placenta, placenta previa,
and chronic illnesses in the pregnant
adolescent. It woi:ld appear as if some
other causative factor was responsible
for the general increase in prematurity
among this group.

The economic and social liackground
of the non-white population in our ma-
terial is not as favorable as in the white
population. Poor economics have been
indicted as a factor responsible for the
increase in prematurity rates in our non-
white population. This factor does not,
however, explain the increased prematur-
ity rate in the adolescent mother in both
the white and non-white population.
There is no satisfactory ex])lanation at
once apparent in our data to account for

Vol. 49. No. 1

HASKLXS—REPRODUCTU'E BEHAJ'IOR OF THE ADOLESCENT FEMALE

Table 3. Adolescent Obstetrics: Fetal Complications,
University of Maryland Hospital 1950-59

White

Per Cent

Non-White

Per Cent

PREM.\TTRE BIRTHS

Adolescent mothers

Adult mothers

188
1,167
1,355

42
464
506

109
684
793

27
140
167

62
614
676

10.73

8.80
9.02

2.40
3.50
3.37

6.22
5.16

5.28

1.54
1.06
1.11

3.54
4.63
4.50

950
1,796

2,746

236
597
833

238
569

807

90
143
233

171
407

578

17.87
16.10

'^rotal mothers

16.67

PERINATAL MORTALITY

Adolescent mothers

4.44

Adult mothers

Total mothers

ABNORMAL PRESENTATION

Adolescent mothers

Adult mothers

Total mothers

5.35
5.06

4.48
5.10
4.90

MULTIPLE PREGNANCY

Adolescent mothers

1.70

Adult mothers

1.28

Total mothers

1 41

FETAL ANOMALY

Adolescent mothers

3.21

Adult mothers

3.65

Total mothers

3.51

the increased prematurity rates in the
adolescent mother although primigravid-
itv may be a contril)uting factor.

Perinatal Mortality. An important in-
dication of the reprocktctive potential of
any group is the perinatal mortality rate.
Perinatal mortality is an all-inclusive
term including anteparttini, intra])artum,
and neonatal fetal mortality. This is
ordinarily defined in terms of perinatal
deaths ])er thousand live births. Perinatal
mortality in this study is defined as fetal
deaths ])er hundred births and is tab-
ulated in Tal)le 3B.

Prematurity is an important contrib-
utor to perinatal loss. Prematurity has
been demonstrated to occur with a great-
er frecitiency in the adolescent parttirient.
It might be reasoned that perinatal
loss would occur with a greater fre-
(|uency among the children of the adoles-
cent mothers. The data indicate, how-
ever, a greater perinatal mortality rate
in the adult pregnancies.

A partial explanation for this dis-
crepancy may be found in the considera-
tion of a greater incidence in maternal
disease complicating pregnancies in the
adult mother than in the adolescent
mother. This wottld compromise the in-
fants of the adult mother even beyond
the prematurity factor.

Perinatal mortality occurred with a
significantly greater frequency in the
non-white pregnancies. This is probably
the result of a variety of causation factors
including an increase in disease com-
plicating pregnancy in the non-white
group as well as cultural, economic, and
ethnic factors.

Abnonnal Presentation. The frequency
of abnormal ])resentation of the fettts is
tabulated in 3C. There were 1.600 ab-
normal presentations recorded in the to-
tal material. This is the usual frequency
of occurrence. There was no real differ-
ence in occurrence of abnormal presenta-

Jdiiuary, 1'^'04

BULLET IX OF THE SCHOOL OF MEDICI SE. UXU'ERSITY OF MARY LAX D

Table 4. Adolescent Obstetrics: Maternal Complications,
University of Maryland Hospital 1950-59

White

Per Cent

Non-White

Per Cent

TTERINE INERTIA

Adolescent mothers

Adult motliers

342
397

79
181
260

67
300
367

1
68
69

242
265

195

947

1,142

37
475
512

3.14
2.57
2.64

4.51
1.36
1.73

3.82
2.26
2.44

0.06
0.51
0.46

1.31
1.82
1.76

11.13
7.14
7.60

2.11
3.58
3.41

276
395
671

795

338

1,133

302
357
659

5
47
52

81
235
316

1,025
1,797

2,822

202
632
834

5.19
3 54

All mothers

4 07

CONTHACTED PELVIS

Adolescent mothers

14 95

Adult mothers

3 03

All mothers

6 88

PROLONGED LABOR

Adolescent mothers

5 68

Adult mothers

All mothers

3.20
4 00

PLACENTA PREVIA

Adolescent mothers

0 09

Adult mothers

All mothers

0.42
0.32

PREMATURE SEPARATION
OF PLACENTA

Adolescent mothers

1 52

Adult mothers

2 11

All mothers

1 92

PRE-ECLAMPSIA

Adolescent mothers

19.27

Adult mothers

16 10

All mothers

17 12

CESAREAN SECTION

Adolescent mothers

3.80

Adult mothers

5.66

All mothers

5.06

tioii among the adult, adolescent, white,
or non-white parturients.

Fetal Anomalies. The incidence of
multiple pregnancy and other fetal an-
omalies is indicated in Tahle 3D and 3E.
Studies involving greater numbers of
patients than ours have shown that there
is a greater incidence of twinning in the
non-white mother than in the white
mother. There is also a trend toward an
increasing incidence of multiple preg-
nancy in the older gravid female. The
University of ^Maryland Hospital data
fail to corroborate these general observa-
tions. This lack of agreement may be re-
lated to the size of the sample involved.

Our data does, however, confirm the
observation that fetal anomalies in gen-
eral occur with a lesser frequency in
the offspring of the younger than of the
older mother.

Maternal Mortality. There were 43
maternal deaths in the 31,495 pregnan-
cies. This is a maternal mortality rate of
approximately 14 per ten thousand births
or 0.14^/c. All of the maternal deaths
occtirred in the adtilt pregnancy group.
If the maternal death rate had been the
same in the adolescent pregnancies as in
the adult pregnancies, we could have ex-
])ected 10 deaths in the 7.069 adolescent
pregnancies.

Vol. 49. Xo. 1

HASKIXS— REPRODUCTIVE BEHAVIOR OF THE ADOLESCENT FEMALE

Uterine Inertia. Primary uterine iner-
tia occurs with a frequency approximat-
ing 2% of all labors. It is more fre-
quently found in the primigravida. Anxi-
ety is a prominent personality factor in
patients with uterine inertia.

In the adolescent pregnancy group
there is a jiredominance of primigravida.
This factor, plus an immature personality
structure in the adolescent parturient,
might contribute toward the greater in-
cidence of uterine inertia in this age
grou|). Our analysis, as indicated in
'liable 4A. shows a significant increase
in uterine inertia in the adolescent non-
white i)opulation when compared to the
adult non-white population. There is a
greater occurrence of uterine inertia
among the adolescent white group when
compared to the adult white group, Init
the difference is not necessarily signifi-
cant. There is a greater incidence of
uterine inertia in the total non-white
population as compared to its incidence
in the total white population.

Contracted Pelvis. Sexual precocity in
the human female is associated with an
initial acceleration of somatic growth.
The final growth achieved by the sex-
ually jjrecocious female is ordinarily less
than the normal standard for the popula-
tion. This is assumed to be the result of
])remature epiphyseal closure of the long
bones associated with ])recocious sexual
deyelo])ment.

It is (juite apparent from the age dis-
tribution of this study that our adolescent
pregnancy grou]~) would tend to contain
tliose individuals whose se.xual develop-
ment was somewhat earlier than the aver-
age. Although not necessarily classified
as sexually precocious, sexual maturation
would luidoubtedly be occurring at the
earlier levels of estalilisbed norms. It
would follow from this that ])elvic con-
traction coulcl occur with a greater fre-

quency among the adolescent pregnancies
than in the adult pregnancy group. Ex-
amination of our data, Talile 4B, indi-
cates a marked increase in contracted
pelvis in the adolescent pregnancy group
in l)oth the white and non- white poj^ula-
tion.

It has been noted previously that con-
tracted pelves occur more frequently
among the non-white than the white pop-
ulation. Our data corroborate this ob-
servation. Contracted pelvis in the ad-
olescent non-white group occurs with a
freciuency approximating three times that
of the white adolescent pregnancy group
which is also about the same magnitude
found in the adult population compar-
isons.

Prolonged Labor. Preceding data in-
dicate a greater frequency of uterine in-
ertia and contracted pelvis among the
adolescent population. It is recognized
that these are two of the major causes
of prolonged labor. The data on pro-
longed labor are approached with the
anticii)ation that the adolescent preg-
nancy group would have a greater inci-
dence of prolonged labors than would the
adult pregnancy group.

In this study, prolonged laljor is de-
fined as labor in excess of 20 hours. As
indicated in Table 4C, there is a sig-
nificant increase in the incidence of pro-
longed labor among the adolescent par-
turients whether in the white or non-
white po|)ulation. This was considered to
support our previous deduction. The
study further indicates an increased in-
cidence of prolonged lal)or in the total
non- white population as compared to the
total white population.

Placenta Previa. It has been ol)seryed
that i)lacenta previa is a more frequent
complication of pregnancy in the multi-
parous females than in the primigravida.
In view of the weighting of the adoles-

Jiuniarw l'-'f)4

BULLHTIX OF THE SCHOOL Of MfiDICIXE. UMnik'SII)- OF MAIO'LAXD

cent pregnancies by priniigravida, a
lesser incidence of j^lacenta previa would
be ex])ected in tbis group. Tbe total
incidence of ])lacenta previa was found
to approximate 0.5 "^v . Tbis is tbe gen-
erally accepted incidence of ])lacenta
previa in tbe United States.

Tbe data in Table 4D support tbis con-
clusion in tbat tbe adolescent pregnancy
group sbows an incidence of placenta
previa approximately one-tentb tbat of
tbe adult motbers. Tbis difference in in-
cidence remains constant wbetber in tlie
wbite or non-wbite population.

Prciiiatitre Separation of Placenta.
Premature separation of tbe placenta oc-
curs witb a greater frequency among
tbose women in wbom pregnancy is com-
plicated by hypertension. Tbe etiology
of tbe hypertension may be pre-eclamptic,
nephritic, or essential. Since hyperten-
sion is considered to occur with a greater
frequency among populations with in-
creasing age, except for the factor of pre-
eclampsia, it could be predicted that pre-
mature separation of placenta would
occur with lesser frequency among the
adolescent than among the adult preg-
nancy group.

In referring to Table 4E. it becomes
immediately apparent that there is a
lesser incidence of premature separation
of the placenta in the adolescent preg-
nancies. The numerical difference pres-
ent in both tbe white and non-white
groups is considered to be significant in
tbe non-white group only. Though a
difference exists in the wbite population,
tbe difference is not necessarily signifi-
cant.

Prc-cclanipsia. Pre-eclamptic toxemia
of pregnancy occurs with a predictable
increase in frequency among tbe young
priniigravida. This should lead to an in-
crease in pre-eclampsia in our adolescent

])regnancy group, since they are obvious-
1\ young and also have a high incidence
of primijiarity. As indicated in Table
4b\ tbe usual distribution of pre-
eclampsia is corroborated. There is an
increase in tbe rate f)f ])re-eclamptic
toxemia in tbe adolescent pregnancy
wbetber in tbe wbite or non-wbite ])oi)-
ulation. There is also an increased tox-
emia rate in the total non-wbite popula-
tion as compared to the total wbite pop-
ulation. These data can be interpreted
to sujjport tbe axiomatic consideration
indicating tbat pre-eclamptic toxemia of
])regnancy is a disease of young primi-
gravidas of low economic and social
background.

Cesarean Section. The two most com-
mon indications for cesarean section are
previous cesarean section and cephalo-
l)elvic disproportion. It has previously
been established that contracted pelvis
occurs with a greater frequency in the
adolescent pregnancy group. There is a
greater incidence of prolonged labor and
uterine inertia in the adolescent group.
It might be expected that cesarean sec-
tion would occur with a greater fre-
quency in the adolescent group than in
tbe adult population.

This conclusion is not borne out by
these data, see Table 4G. The reason
])robably being that previous cesarean
section has a greater numerical impor-
tance as an indication for cesarean sec-
tion than contracted pelvis, uterine iner-
tia, or prolonged labor. It is quite ob-
vious that as the patient ages she may
enter into the category of adult preg-
nancies with a previously scarred uterus
and with a continuing indication for
cesarean section. This would tend to
weight the adult pregnancies dispropor-
tionately due to tbe incidence of repeat
cesarean sections. Tbe lesser incidence of

I'ol. 4Q. Xo. 1

HASKIXS— REPRODUCTIVE BEHAl'IOR OF THE ADOLESCENT FEMALE

])reinature separation of placenta and
placenta previa in the adult groups would
favor an increased cesarean section rate
among the mature parturients.

SUMMARY

The reproductive hehavior of adoles-
cent females at the University of Mary-
land Hospital from 1950 through 1959
was reviewed. The data revealed an in-
creased incidence of uterine inertia, con-
tracted pelvis, prolonged labor, pre-
eclampsia, and prematurity in the adoles-
cent pregnancies. There was a lower in-
cidence of placeta previa, premature sep-
aration of the placenta, cesarean section,
and fetal anomalies in the adolescent
pregnancy group.

Comparative studies of the non-white,
white populations revealed a greater in-
cidence in the non-white group of uterine
inertia, contracted pelvis, premature sep-
aration of the placenta, prolonged labor,
pre-eclamptic toxemia, cesarean section,
prematurity, perinatal mortality, and
multiple pregnancy. There was no sig-
niticant difference in incidence of pla-
centa previa, fetal anomaly, or abnormal
presentation in the white or non-white
population.

References

1. Israel, S. L., and Woutersz, T. B. :
Teen-Age Obstetrics. Am. J. Obst. & Gynec,
85:659, 1963.

Jauiiary. 10^4

A Controlled Suidy of Er> lliroiii\ ciii in Acne
Therapy

HARRY M. ROBINSON, JR., M.D.

Sttdiks kv Rol)ins()n.' Sul/J)C'ri;er and
P>aer.- and Andrews'' indicated that broad
spectrum antil)iotic thera])v was of great
\alue in the modern approach to the man-
agement of acne. These investigators
demonstrated that certain orally admin-
istered antil)iotic drugs were of value in
the treatment of acne papules and pus-
tules. l)Ut when these medications were
discontinued, the lesions recurred. It
was observed that a satisfactory result
could be maintained in many patients by
the continued administration of antibi-
otics at periodic intervals or by using
small doses of the selected medication.
Although the specific mode of action of
these drugs in the treatment of acne has
not l)een determined, Sulzberger- sug-
gested that the beneficial effect could
possibly be due to the action exerted
against internal foci of infection rather
than a direct action on the cutaneous
lesions. It was the consensus of opinion
that ])enicillin was of no value in the
treatment of acne vulgaris.

The study conducted by Robinson^ in-
dicated that chloramphenicol, the tetra-
cyclines, and erythromycin stearate were
equally effective in the treatment of acne
vulgaris. Penicillin, administered orallv
or by injection, was of no value in the
treatment of acne vulgaris.

The following long-term study was
conducted with erythromvcin stearate, a

From the Division of Dermatology, Department of
Medicine, School of Medicine University of Maryland,
Baltimore. The erythromycin stearate used in this
study was furnished as 250 nig. filmtabs by Dr. George
Berryman of Abbott Laboratories, North Chicago,
Illinois.

drug producti\e of few adverse reactions,
to determine its eff'ectivity in the treat-
ment of a large series of patients who had
acne vulgaris, acne rosacea, or acne con-
globata. This form of erythromvcin has
not been associated with to.xic effects on
the li\er or other organs.

Methods and Materials

Patient selection: The patients includ-
ed in this study were examined and
treated in the author's private practice
and in the out-patient department derma-
tology clinic of University Hospital. Both
white and negro patients were included.
The age range was from 12 to 60 years.
Except for acneiform eruptions, the 132
cases on which observations were com-
pleted, were in general good health.

The treatment periods range from
three to ten months. Patients completing
less than two months of treatment were
not included in this series.

The drug: Erythromycin stearate was
dispensed in 250 mg. coated tablets
( Filmtab ). Inositol Niacinate in 200 mg.
capsules was used as a control to treat 30
patients inckided in this study. A previ-
ous investigation^ had proved this drug
to be ineffective and therefore it could be
used as a satisfactory control.

Dosai/e seliediile of erythroniyci)i stea-
late: Treatment was initiated with a dose
of 250 mg. of erythromycin stearate four
times daily until improvement was noted.
F'atients who did not show satisfactory
improvement or i)artial improvement
after a period of fottr weeks were dropped
from the study. Thirty patients who had

Vol. 49, No. 1

ROBINSON— CONTKOLLIil) STUDY OF ERYTHROMYCIN IN ACNE

improved on treatment with erythromy-
cin stearate after four weeks were given
200 mg. of inositol niacinate four times
daily in place of the antiliiotic. This was
continued for foin- weeks and after re-
lapses were noted in all of them, the
erythromycin stearate treatment was re-
sumed. Prior to antihiotic therap\-. all
])atients included in this study had heen
treated with dietary restrictions, im-
l)roved hygiene, and local ap])lications of
colloidal sulfur lotions. The local meas-
ures were continued throughout the
period of antil)iotic thera])y.

Results

Of the 66 patients with acne vulgaris,
42 were greatly im])roved, 16 partially
improved, and 8 were not benefited. The
degree of improvement was based on
disappearance of pustules and papules,
and the rapidity of response to institu-
tion of erythromycin stearate treatment.
After four weeks, the dose was reduced
and it was possible to maintain 20 of
these patients in a state of remission with
a single 250 mg. tablet of erythromvcin
stearate daily. Sixteen patients main-
tained improvement with a dose of 250
mg. of the antil)iotic twice daily. In 14
patients it was possible to maintain im-
provement with alternating rest periods
of two weeks and two weeks of erythro-
mycin stearate. Although papules and
pustules disappeared under treatment
with this antibiotic, it was found to have
no effect on the presence of comedones or
excessive sebaceous secretion.

Of 41 i)atients with acne conglobata,
Z2i imj^roved under treatment with
erythromycin stearate as expected, the
results were less striking than those
obtained in acne vulgaris. Twenty-five of
these patients were greatly improved,
eight were partially improved, and eight
were unim])roved. It was not i)ossible to

maintain improvement in any patient
w ith a single 250 mg. tablet of erythro-
mycin stearate daily, but 31 of this group
maintained improvement on two tablets
daily. Using the same scheme of alternat-
ing rest periods that was employed in the
treatment of acne vulgaris patients, two
of this group maintained improvement.

Gratifying results were obtained in the
treatment of patients with acne rosacea.
Eighteen of 25 patients were greatly im-
l)roved and five were partially improved.
Only two patients in this series were not
beiiefited bv the treatment. After a mini-
mum of six months of continued treat-
ment, ten patients maintained improve-
ment on single daily dosage, nine on two
taljlets of erythromycin stearate daily,
and four maintained improvement on al-
ternating rest periods and periods of
medication.

Adverse reactions were minimal. Two
patients had severe diarrhea and were
forced to discontinue treatment. Alild
gastrointestinal disttirbances were ob-
served in six patients.

Comment

While it is generally recognized that
endocrine iml)alance is basically res])onsi-
ble for the j)roduction of acne lesions, safe
and eft'ective measures for the correction
of such dysfunctions have not been dis-
covered. The factors which play a large
part of the production and aggravation
of acne lesions include infection, emo-
tional stress, dietary indiscretion, and
])Oor body hygiene. \\'hen all facts are
taken into consideration, it is obvious
that the treatment of acne nnist be spe-
cifically tailored for the individual. The
role played by infection in production of
acne pustules is not clearly understood.
1 Seeker'" performed bacteriologic studies
in 65 patients. He found a variety of
organisms including hemolytic sta])hylo-

Jdiiuarv. 1Q64

BULLETIX OF THE SCHOOL OF MEDIClMi. V Ml' F.RSITY OF MAKVLAM)

Systematic Administration of Erythromycin Stearate in Acne

Manifestalion

Severitv ^°- "' Greatly
severity patients improved

Partially Un-
improved improved

Maintained

improvement

on 250 mg.

daily

Maintained
improvement
on 250 mg.
twice daily

Maintained
improvement
with alter-
nating rest
periods and
periods of
medication

Aciic
\"ulgaris

Mild 20 15

3 2

Moderate

6 2

9 5

Severe

23 12

7 4

Acne

Congiobata

Mild

Moderate

Severe

Acne
Rosacea

Mild

Moderate 15

3 16

Severe

5 3

coccus allnis, non-heinolytic staphlococcus
albus. hemolytic staphylococcus aureus,
non-hemolytic staphylococcus aureus, and
a mixture of bacteria.

A clinical history and physical survey
should be a part of the treatment routine.
Good physician-patient rapport, improved
hygiene, dietary restrictions, and other
general measures are effective and should
be instituted as the initial part of the
regime in the management of acne.

Although topical therapy is necessary,
the preparations usually applied to the
skin surface do not produce dramatic
improvement. In a recent study*' using a
large number of preparations imder blind
label, it was determined that creams and
lotions which contained sulfur, resorcin,
or a combination of the two with or
v.'ithout hydrocortisone were no more
eft'ective in many instances than the
placebo alone.

In view of the fact that long continued
antibiotic therapy is necessary to obtain
and maintain a satisfactory result in the
treatment of acne vulgaris, caution must
be observed to avoid serious adverse re-
actions. In order to avoid destruction of

the normal flora of the intestinal tract and
skin, rest periods of two weeks alternat-
ing with two weeks of antibiotic therapy
ha\-e proved to be the most satisfactory
method of treatment. Erythromycin
stearate which has a low incidence of
adverse reactions is a valuable drug in
the treatment of acne, but it must be em-
l)hasized that it does not replace any of
the standard methods in present day use.
It should be intended as supplementary
therapy.

The control drug in this study, inositol
niacinate in a dose of 200 to 400 mg.
four times daily proved to be ineffective
in the treatment of acne vulgaris in 50
patients. In the initial study^ no adverse
reactions were recorded. For these two
reasons this drug was considered to be
ideal for use as a control. Thirty patients
previously treated with this medication
were subsequently given erythromycin
stearate, 250 mg. four times daily. After
improvement was observed, the antibi-
otic was discontinued and treatment with
inositol niacinate resumed. After several
weeks, relapses occurred in all 30 patients
and when erythromycin stearate therapy

Vol. 49, No. 1

ROBINSON— CONTROLLED STUDY OF ERYTHROMYCIN IN ACNE

Vv'as resumed, improvement was promjit.
This experiment in 30 patients proved
conclusively that the erythromycin stea-
rate was a valualile adjunct in the tiierapy
of acne.

In previous studies, it was observed
that antibiotic therapy was not curative
in the treatment of acne but will produce
})artial to complete involution of lesions.
When these drugs are discontiiuied.
lesions will imariahly recur and when
readministered. the lesions will involute.
Bv careful manipulation, it is possible to
determine the maintenance dose required
and this le\el should he obtained as soon
as possible. Alternating rest periods with
periods of medication is the most desir-
able scheme of treatment.

Conclusions

The antibiotic drug, erythromycin
stearate, is a valuable supplement in the
management of acne vulgaris, acne con-
globata, and acne rosacea. Although the
value of such treatment is recognized, it
does not replace radiation therapy, die-

tarv measures, and proper local therapy.
Long continued administration of anti-
biotic drugs without supervision and rest
periods is not advisable. Improvement
may be maintained in a large percentage
of patients by the administration of small
maintenance doses.

References

1. Robinson, Harry M., Jr.: Role uf Anti-
biotics in Therapy of Acne, A.M. A. Arch. Der-
matol. & Syphilol.. 69:414-17, 1934.

2. Sulzberger, M. B. and Baer, R. L. : The
J949 Year Book of Dermatology and Syphilol-
('(/y. Chicago, The Year Book Publishers, Inc.,
1950, p. 29.

3. Andrews, G. C, Domoxkos, A. X., and
Post, C. F. : Treatment of Acne Vulgaris,
J.A.M.A., 146:1107, 1951.

4. Robinson, H. M., Jr. : Unpublished data.

5. Becker, F. T. : The Acne Problem.
A.M.A. Arch. Dermatol. & SyphiloL, 67:173.
1953.

6. Robinson, H. M., Jr., Robinson, R. C.
y., and Hollander, Mark : Sebaceous Secre-
tion and Comedones (Quantitative Study),
Bull. School of Med. Univ. of Md.. Vol. 47.
No. 3, 1962.

Januarw 1964

John James Aiidiiboii''s
Balliiiiore Physician Patrons

G. E. GIFFORD, JR., M.A., M.D.

John James Audubon came to Balti-
more in 1833. soliciting, subscriptions to
his classic, Birds of America. In a letter
dated October 11, he wrote. "I have
some hopes of the Library of Baltimore
and also of the College of Sitrgeous:'^
A postscript to the letter reads. "I have
rose from my Dinner to Receive the
Subscription of E. Geddings Escf M.D.
Baltimore."- At that time Dr. Eli Ged-
dings (1799-1878) was Professor of
Anatomy and Physiology (1831-1837)
and Dean (1832-1834, 'l836-1837) of
the University of Maryland Medical
School. ^"^ He started a quarterly journal,
the Baltimore Medical and Surgical
Journal, in 1833, which he changed to a
monthly in 1834, giving it then the name
North America)! Arcliiz'es of Medical
and Surgical Sciences. Volumes II and
\' of Ornithological Biography, the text
accompanying Audubon's plates, list
Geddings as a subscribers*^ and entries
in Audubon's letters reveal their finan-
cial dealings. ss Dr. Eli Geddings left his
chair at the University of Maryland in
1837 and returned to his native Charles-
ton, South Carolina. On the burning of
Columbia at the close of the Civil \\'ar,
Cieddings' entire fine library, which had
been sent there from Charleston for
safety, was destroyed.^ The Audubon
folio must have been burned too ; Ged-
dings' descendants do not know of its
existence. s-

A colleague of Dr. Eli Geddings was
Professor Jules Timoleon Ducatel (1796-
1849 )''^--'' who was described as an

Portrait of ¥.\\ (Jeddings, M.D.. from an unattributed

engraving in the Charleston Medical Journal and

Review.

(Courtesy of Joseph I. Waring. M.D.)

"ardent and enthusiastic student of na-
ture" and "ever ready to impart his
knowledge to others. "S' His father, Ed-
mund Ducatel. a celebrated Baltimore
druggist, had been one of the Baltimore
subscribers to Alexander Wilson's Amer-
ican Ornithology.-^ Dr. Ducatel was a
Professor of Natural Philosophy in the
Mechanics' Institute before he became
Professor of Chemistry at the University
of Maryland Medical School (183U
1837). Ducatel subscribed to the smaller
edition of Audubon's Birds of Amer-

Vol. 49, No. 1

GIFFORD—JOHN JAMES AUDUBON'S BALTIMORE PHYSICIAN PATRONS

jca,^9, 25 gj^(-| according to an Audubon
letter dated Charleston, S. C, October
25th, 1833, Dr. Ducatel gave Audubon
the name of one of his medical students,
Thomas Edmondson, Jr.-^

Sn< —

My I-"riencl J. T. Ducatell writes me
that it is your desire to reecivc from me,
a memorandum explanatory of tlie manner
in which the pubHcation of my Work
entitled "The Birds of America" is car-
ried on ; tlie price of this work, time of
completion & etc. This I now will do
with the more pleasure knowing that you
are naturally yourself a student of Nature.
"The Birds of America" will form 4 Folio
Volumes each containing one hundred
plates, — the last perhaps more ? The whole
is published in numbers each of 5 plates
of which 5 or 6 or perhaps 7 numbers
come out annually — the cost of each of
these numbers is ten dollars payable on
delivery of the same or when called for.—
Persons subscribing at this time receive
the four volumes yS bound in Russia
leather for which they have to disburse
200 dollars for the 20 numbers contained in
it & 20 more for the price of the binding —
the 2<i volume will be finished in August
or Sept>' ne.xt and when fhaf is delivered
the same sum of 220 $ will have to be
paid — after this the subscriber will receive
the X^s for the 3d Volume as they are
forwarded from England and pay for them
when askd — It will take in all probability
Eight Years now to finish the Work from
this state. The 2 first volumes contain
Land birds — the 3rd Water birds and the
4 birds of both classes to enable me to
introduce all subsequent discoveries from
after the finishing of the 3rd volume —

One volume of letter press accompanies
each vol of Illustrations and if paid for
separately — the cost of each of these about
4 Dollars-
Believe me with great respect

Your very obt. Svt.

John J. Audubon
to Edmundson Esqr.
Baltimore

P.S. Should you please to honor me with
your subscription to my Work, have the

goodness to write to me at this place care
of Revd John Bachman —

In 1834 Audubon returned to Balti-
more, where in a letter of March 7 he
wrote "I wish to make 5 or 6 drawings
of Ducks here and will probably spend a
month at this city."-'' Approximately one
month later, in a letter April 5th he
confessed, "I did next to nothing at Bal-
timore in the Bird-way — Drew only a
Male canvas-back Duck — but I obtained a
new subscriber — that was something!"-^
The next day he recorded in a letter,
"Thomas Edmundson, Jr. — New Sub-
scriber 1st V'e 220.00.'"-'9 Edmondson
was listed as a subscriber in both Vol-
umes II and V of the OrnithoJogical Bi-
ograpliy}^

Thomas Edmondson, Jr., M.D. (1808-
1856) ^^o-^'^ was graduated from the Uni-
versity of Maryland School of Medicine
in 1834, but never practiced his profes-
sion. Inheriting wealth, he became a
patron of the arts and "with whom art
collecting was more an obsession than a
gentlemanly pursuit" ;-^^ he owned eight
cellos and fifteen violins, of which two
were by Stradivarius and one by Guan-
narius. His home, "Harlem," was given
to the city of Baltimore upon his death,
and Edmondson Avenue in Baltimore
is named for him.^^ Edmondson amassed
a huge library including Audubon's Birds
of America and Quadrupeds of North
America. In his will-^^ Edmondson left
directions that his books and picttires
were to be divided among the children,
hut at his death his collection was de-
posited in the Maryland Historical So-
ciety and dispersed by i)ublic sale in
1870. Item #351 in the catalog of Ed-
mondson's library is Audubon's Birds of
America. A copy of this catalog anno-
tated by a Sanuiel I. Harper lists
"Warren" as purchaser and the auc-

Jaiiuarv. l'^>64

BULLETIN OF THE SCHOOL OI- MEDICIXE. IWirJiRSITV OF M.IIO'L.IXP

,//.

7/ /////. i

^ r////^ /////

//// ///r.j/ //

Book plate of Thomas Edmondson, Jr., M.D., in

his set of Birds of America, now in the Cincinnati

Public Library.

tioiieer's copy lists "$750.00" as tht
selling price. •^''

This "Warren" may have heen a Cin-
cinnati book dealer, Alfred Warren,
"wholesale dealer in periodicals, news-
papers, magazines and cheap publica-
tions,"^'' who acted as an agent for Joseph
Longworth of Cincinnati. The Pul)lic
Library of Cincinnati purchased the
Audubon folio from Joseph Longworth
for $1,000.00 in 1870. Today the set is
still in that library in the Rare Book-
Room, bearing the original 3^/4 x 2.)4
book plate of Thomas lulmondson, Jr.-^''

Nathaniel Potter, M.D. (1770-
1843)^^^"'*^ was one of the founder.s of
the University of Maryland School of
Medicine and its Dean in 1812 and 1814.
He occupied the chair of Medicine from
1807 to 1843 and is chiefly remembered
t(jday for his theories on the etif)logy of
yellow fever and as sometime editor of
the Baltimore Medical and Philosophical

Lyceitiit. None of the existing biograph-
ical material mentions his interest in
natural history or ornithology, but he
had been a contributor to the classic,
.Imcrican Oruitholoc/y^' of .Mexander
Wilson, 'i'his includes a letter, "which as
it contains some new and interesting
facts, and several amusing incidents, il-
lustrative of the character of the birds,
1 shall with ]>leasure lay before the
reader." The letter was a description of
tlie Cow-Bunting, today called the Cow
bird. It begins, "I regret e.xceedingly that
])rofessional avocations have put it out
of my i)ower to have replied earlier to
your favor of the 19th of September ; and
although 1 shall not now reflect all the
light you desire, a faithful transcript
from memoranda, noted at the moment
of observation, may not l)e altogether
uninteresting." Then follows a footnote
with clinical overtones.

It may not be improper to remark here,
that the appearance of this bird in Spring
is sometimes looked for with anxiety by
the farmers. If the horned cattle hapi)ened
to be diseased in Spring, they ascribe it
to worms, and consider the ])ursuit of the
birds as an unerring indication of the
necessity of medicine, .-\lthough this
hy])othesis of the worms infesting the
cattle so as to produce much disease is
problematical, their super abundance at
this season cannot be denied. The larvae
of several species are deposited in the
vegetables when green, and the cattle are
fed on them as fodder in winter. This
furnishes the principal inducement for the
birds to follow the cattle in Spring, when
the aperient effects of the green grasses
evacuate great numbers of worms. .\t this
season the Pccctris often stuffs its crop
with them till it can contain no more.
There are several species, but the most
numerous is a small white one similar to,
if not the same as, the . Iscaris of the
human species.

X'ot only had Potter made memoranda
and o])served the birds' food habits, he

Vol 49. No. I

GIFFORD— JO/IN JAMES AUDUBON'S BALTIMORE FHYSICIAN PATRONS

had offered, "a premium for the nest,
and the Negroes in the neighborhood
brought me a variety of nests ; but they
were always traced to some other bird."
1'hen follows a detailed account of the
cow ])irds" nesting habits, song, and
copulatory beliavior. The letter ends.

This, sii-, is tlic amount of my infor-
mation oil tliis sul)ject, and is no more
than a transcript from my notes made
several years ago. For ten years past, since
I have lived in this city, many of the im-
pressions of nature have been effaced, and
artificial ideas have occupied their places.
The pleasure I formerly received in view-
ing and examining the objects of nature
are, however, not entirely at your service.
With the sincerest wishes for the success
of your useful and arduous undertaking, I
am, dear Sir, yojrs very respectfully,
Nathaniel Potter. .

Dr. Potter is not listed as a subscriber
to Wilson's .liitcrican Oniithology,'^^ but
he did subscribe to Audubon's Birds of
America.-^" luitries in iVudubon's letters
indicate some financial dit^culty on Pot-
ter's i)art.-'" Potter is not listed as a sub-
scril)er in the Ornitliohxiical Bioyrapliy^''
but in Ledger B of Audubon, now in
the Atidul)on Museum, Henderson, Ken-
tucky, there is the following entry, "103
— Potter. Nathaniel — Baltimore, July
18th, 1835 — C." The "C" means that the
total sul)scription was completed;"'' how-
ever, as late as February 21, 1840, Audu-
l)on wrote "Dr. Potter is very ill and
poor and yet I hope to get his note before
1 leave here. "5- Potter's set of the Birds
of America is most likely the set in the
Tilden Library, New York Public Li-
l)rary ; on the reverse side of plate No.
()(), plate CCCXXVI in volume 4 there
is a i)encilled inscription, "Nos. 63, 64.
65. 66. for Nath^ Potter. b:sq. M.D."53
Mr. Tilden acquired tliis set for his
lil)rary in 18<)5. We know that Potter
(lied in pentn-y in 1843 and that most

likely his library was sold. The where-
abouts of the set from Potter's purchase
in 1835 to 1895, a 60-year span, remains
unknown.

Tlic last physician-nattu"alist patron of
Audu])on was (lideon ]>. Smith. An ento-
mologist of sorts, he was graduated from
the University of Maryland in 1840.5'^
Dr. Smith became j. j. Audubon's agent
in P)altiniore and Audubon named a bird.
Smith's Longspur, for him. The location
of Dr. Smith's copy of Audubon's Birds
of America is tniknown, but an Audubon
letter to G. P>. Smith is part of the
Thayer Collection of Audubonalia at
Houghton Library. Harvard Univer-
sity.^^ It is of particular interest since
there is a brief signed note by Dr. Smith
at the l)()ttoni of it. The letter reads as
follows :

Fort L^nion. M° 3 miles aliove

the Yellow Stone River,
Lat. 47° 20' North

June 13th. 1843

Mv Dear Friends,

We arrived safe and all well yesterday
afternoon at this place, which is unlike
anything I ever saw before. I cannot write
you a long letter on a/c of the confusion
and excitement at this moment around us.
We are in the very midst of the Game
Country. We saw yesterday no less than
22 Mountain Rams together, scampering
over the High Clay Hills close to our
Boat — we have made the quickest trip
ever performed by man to this place, and
tliat without touching a single snag or
having scarcely an accident worthy of
remark.

We intend leaving this place, on our way
downward, on the 15th or 20th of August
and proceed slowly to afYord us all oppor-
tunities possible to collect what ever we
can. As well as knowledges of things that
we coiihi not study from the deck of a
steamer.

Pledge to write to \'ictor or John when
you receive this, and pledge also remem-
i)er me kindlN- to your good wife and

Jaiuicirv. F>64

Smith's Longspur, Birds of America. Philadelphia and New York, J. J. Audubon, Volume VII,

1844, plate 487, p. 337.

daughter and my friend and believe me
always yours sincerely,

J. J. Audubon
Baltimore July 10, 1843

My Dear Sir,

I am sure you will accept my congratu-
lations on the contents of the above wel-
come letter. I am getting about again but
slowly. In haste for the mail.

Yours,

Gideon B. Smith

The close relationship of natural sci-
ence and medicine in the revolutionary
era of America has been pointed out.^^' ^^
This continued into the frontier stage as
illustrated by the vast amount of orni-
thology done by Army physicians. ^^ The
patronage of Audubon l)y a group of
I->altimore physician-naturalists indicates
the ties between medicine and natural
science in Baltimore in the early 1830's.
Audubon summarized the situation well,
"At Baltimore . . . my friends . . . Drs.
Potter, Edmondson. Geddings and Du-
catel greatly aided me in augmenting my
list of subscribers . . . my very best
ackncnvleflgements are offered to these

gentlemen for their polite and kind
attentions."''"''

Acknowledgments

I would like to acknowledge the assistance
of the following: Yeatman Anderson III,
Curator of Rare Books, the Public Library of
Cincinnati ; Elizabeth C. Litsinger, Head,
Maryland Department, Enoch Pratt Free Li-
brary ; Joseph I. Waring, M.D., Historical
Library, Medical College of South Carolina;
Alice Hester Rich, Assistant Librarian, Mary-
land Historical Society; Mrs. I. M. Robinson,
Librarian, University of Maryland, Health
Sciences Library ; L. R. Newburn, Acting Li-
brarian, Medical and Chirurgical Faculty of
Maryland; William A. Jackson, Librarian,
Houghton Library, Harvard University ; Har-
old Merklen, Research Librarian, the New
York Public Library; Charles R. Hall, Park
Superintendent, Audubon Memorial State
Park, Henderson, Kentucky ; Professor Joseph
Ewan, Tulane University ; Mr. Waldemar H.
Fries ; and Mr. Richard H. Dickie.

References

1. Corning, Howard (editor) : Letters of
John James Audubon, 1S26-1840. Boston, Club
of Odd Volumes, Volume I, 1930, p. 262.

2. Ibid., p. 263.

3. CoRDELL, Eugene F. : The Medical An-
nals oj Marvland. ]79Q-hSW. Baltimore, Wil-

/(;,'. 49. No. 1

GIFFORD—JOHN JAMES AUDUBON'S BALTIMORE PHYSICIAN PATRONS

lianis & Wilkins, 1903, pp. 53, 89, 95-96, 406-
407, 693, 715.

4. QuiNAN, John R. : Medical Annals of
Baltimore from 1608-1880. Baltimore, Press
of Issac Friedenwald, 1884, pp. 93-94, 102-103,
147-148.

5. Appli'tou's Cyclopedia of America)! Biog-
raphy, Volume 2, ])]). 240, 622; Volume 5, pp.
90.

6. "J- ^I- T." Necrology, Trans. American
Medical Association, Volume 30, 1879, pp.
819-823.

7. In Memorium, Eli Geddings, a Biograph-
ical Sketch of the Professional Career of the
late Professor Eli Geddings, M.D. Charleston,
Walker, Evans and Cogswell, 1878. Presented
to the Medical Society of South Carolina by
Doctors F. M. Robertson, T. L. Ogier and
j. P. Chazal, a Committee appointed for that
])urpose. ( Copy in the Historical Library of
the Medical College of South Carolina.)

8. CoRDELL, Eugene F. : Historical Sketch
of the University of Maryland School of Med-
icine. /(SW-icVW. Baltimore, Press of Issac
Friedenwald, 1891, pp. 77-78, 209, 210.

9. Kellev and Burrage : Dictionary of
American Medical Biography. New York, D.
Applet on and Co., 1928, pp. 458-459.

10. Audubon, John James: OrnitJwlogical
Biography. Volume II, Boston, Hilliard, Gray
and Co., 1835, p. 581. Under subscribers to the
"Birds of America"' obtained since the publi-
cation of the first volume ( 1832) are "E.
(ieddings, Esq. M.D., Baltimore, Maryland
and Thomas Edmondston, Jr., Esq. Baltimore,
Maryland." Audubon, John James, Ornitho-
logical Biography. Volume V, Edinburgh.
Adam & Charles Black, 1839, p. 648. Under

"List of American Subscribers, #58

Smith, Esq. Baltimore, #59 Thomas Ed-
mondston, jun. Esq. Baltimore, #68 E. Ged-
dings, Esq. AI.D., Charleston, South Caro-
lina."

A list of American subscribers is also in
Herrick, Francis Hobart. Audubon the Na-
turalist. New York, D. Appleton and Co.,
1917, Volume II, pp. 380-382.

11. Letters of .lohii .James Auduhan, X'olume
II, pp. 23, 27, 142, 187, 268.

12. Communication of Mr. Waldemar II.
Fries.

13. CoKDKi.i., Eix.EXE F. : Historical .Sketch
of the Uni^'crsity of .Maryland .Scliool of Med-

icine, 1807-1890. Baltimore, Press of Issac
Friedenwald, 1891, pp. 74-75, 77-79.

14. CoRDELL, Eugene F. : The Medical An-
nals of Maryland, 1799-1899. Baltimore, Wil-
liams & Wilkins, 1903, pp. 383, 684, 688, 701.

15. Quinan, John R. : Medical Annals of
Baltimore from 1608-1880. Baltimore, Press of
Issac Friedenwald, 1884, pp. 93-94.

16. Baltimore Sun, April 24, 1949.

17. Anonymous : "The Diary of Robert
Sitmor." Maryland Historical Maga.zi>ie, 1922,
17, pp. 249, 338.

18. Uhler, John Earle : "The Delphian
Club." Maryland Flistorical Magazine, 1925,
20, pp. 306, 329-330.

19. Watters, Robinson : "Audubon and His
Baltimore Patrons." Maryland Historical Mag-
azine, 1943, Volume 38, pp. 7i.

20. HoYT, William D., Jr. : "The Warden
Papers." Maryland Historical Magazine, 1943,
Volume 38, p. 73.

21. Hartridge, Walter Charlton : "The
Refugees from the Island of St. Domingo in
Maryland." Maryland Historical Magazine,
1943, Volume 38, pp. 114-115.

22. HoYT, William D., Jr. : "The Monday
Club." Maryland Historical Magazine, 1954,
Volume 49, pp. 308, 313.

23. Bierck, Harold A., Jr. : "Spoils, Soils
and Skinner." Maryland Historical Magazine,
1954, Volume 49, p. 151.

24. Cantwell, Robert: Alexander JJ'ilson.
Philadelphia and New York, J. B. Lippincott
Co., 1961, p. 287.

25. Letters of John James Audubon. Vol-
ume II, p. 245.

26. Audubon's letter to Thomas Edmondson,
October 25th, 1833, was presented to the ]Mary-
land Historical Society December 7, 1935,
by Edmondson's granddaughters, the Misses
Hough. It is #47294 of the Society's collec-
tion.

27. Letters of John James .Audubon. Volume
II, p. 12.

28. Ibid., p. 15.

29. Ibid., p. 19.

30. Cordell, Eugene F. : Historical Sketch
of tJie Unizrrsity of Maryland School of Med-
icine, 1807-1890. Baltimore, Press of Issac
Friedenwald, 1891, p. 173.

31. . / Century of Baltimore Collecting. 1840-
1<>40. Baltimore Museum of Art, 1940.

Jtinuary. 1^>64

BULLETIN OF THE SCHOOL OF MEDICINE. UNIl'ERSITV OF MARYLAND

32. Westox, Latrobe : "Art and Artists in
Baltimore." Maryland Historical Magazine,
1938, Volume 2>i, p. 220.

2,3. Baltimore Sun, June 12, 1949.

34. Baltimore Sun, obituary, Xovember 26,
1856, Page 1, Column 6.

35. Edmondson's will dated 3 Marcli 1853 ;
probated 9 December 1856, Baltimore, Mary-
land.

36. The Maryland Historical Society has a
copy of "Catalogue of a Splendid Collection of
Books, Being the Private Library of the Late
Thomas Edmondson, Jr., March 17, 18, 19,
1870," annotated by Samuel L Harper. Page
13. after item 351. lists "Warren" as purchaser.

37. Communication of Yeatman Anderson,
III. Curator of Rare Books, Cincinnati Public
Library. The Public Library of Cincinnati has
the four volumes of Audubon's Birds of Amer-
ica. Edmondson's book plate is in each of the
four volumes. Edmondson's copies of the
Synopsis and Ornithological Biography have
been rebound, losing the bookplates.

38. Dictionary of American Biography, Vol-
ume 15, 1935, pp. 131-132.

39. QuiXAX, John R. : Medical Annals of
Baltimore from 1608-1880, Baltimore, Press
of Issac Friedenwald, 1884, pp. 147-148.

40. CoRDELL, EuGEXE F. : Historical Sketch
of the University of Maryland School of Med-
icine, 1807-1890. Baltimore, Press of Issac
Friedenwald, 1891, pp. 4, 85, 88, 107-109, 209-
210. Portrait opposite page 16.

41. CoRDELL, EuGEXE F. : The Medical An-
nals of Maryland, 1799-1899. Williams &
Wilkins, Baltimore, 1903, pp. 21, 43, 51-53,
59-61, 64-65, 73-76, 78, 82, 86-87, 98, 100, S37,
657, 668, 683, 698.

42. CoRDELL, Eugene R. : University of
Maryland, 1807-1907. Volume I, New York,
Lewis Publishing Company, pp. 213-214. Por-
trait 1). 213.

43. WiLLiA.MS, Stephex West: American
Medical Biography. Greenfield, Mass., L. Mer-
riam and Co., 1845, pp. 506-507.

44. Howell, Clewell: "Dr. Nathaniel Pot-
ter wrote a Book." Bulletin of the School of
Medicine, University of Maryland, 1958, Vol-
ume 43, pp. 64-72.

45. Major. Ralph H. : A Flistory of Med-
icine. Volume II, Springfield, Illinois, Charles
C Thomas, 1954, p. 767.

46. "Necrology of Dr. Potter." Maryland
Medical and Surgical Journal, Volume 3, 1843,
P].. 391-392.

47. Wilson, Alexander: American Ornith-
ology. Volume II, Philadelphia, Bradford &
Inskeep, 1810, pp. 152-160.

48. Caxtwell, Robert: Alexander Wilson.
Philadelphia, J. B. Lippincott Co., 1961.

49. Letters of John James Audubon. Volume
I. p. 186.

50. Letters of John James Audubon. \'olunie
I, p. 190; Volume II, pp. 27, 242-243.

51. Communication of Mr. W. Fries.

52. Deaxe, Ruthven : "An Unpublished
Letter of John James Audubon to His Family."
(Baltimore, February 21, 1840) Auk. Volume
25, 1908, pp. 166-169.

53. This inscription was discovered by Mr.
and Mrs. W. H. Fries. This corresponds with
the January 23, 1837, entry into Ledger B,
Audubon Park, Kentucky.

54. GiFFORD, George E., Jr., and Laura T. :
"John James Audubon and Gideon B. Smith,
M.D." Bulletin of the History of Medicine,
1961, Volume 35, pp. 475-477.

55. Audubon's letter of June 13, 1843, to Dr.
(jideon B. Smith is mentioned in his Journal :
Audubon, Maria. Aitdubon and His Journals.
New York, Dover, 1960, \'ol. II, p. 29. It was
published previously in McDermott, John Fran-
cis, Up the Missouri -a'ith Auduboti. Norman,
Oklahoma, University of Oklahoma Press,
1951, footnote pp. 97-98, is given as the source
b} McDermott. Niles National Register, LXIV
(July 29, 1843), p. 347. The original letter,
postscripted by Dr. Gideon B. Smith, is now a
part of the John E. Thayer Collection of
.\udubonaIia deposited in Houghton Library
( HMS AM 1482 [159] ). William A. Jackson,
Librarian, lias given permission for reproduc-
tion.

56. HiXDi.K. Brooke: "The Doctors: Na-
turalists and Physicians." Chapter III, The
Pursuit of Science in Rezvlutionary America,
1735-1789, Chapel Hill, University of North
Carolina Press, 1956, pp. 36-58.

57. Smali.woou, William Martin and
Coox, Mabel Sarah : "What Americans
Studied in European Universities." Chap. II.
Natural History and the American Mind, New
York, Columbia University Press, 1941, pp. 57-
100.

58. Hume, Edgar Erski.ne: Ornithologists
0} the United States Army Medical Corps.
Baltimore, Johns Hopkins Press, 1942.

59. Audubon, John James: Ornithological
Biography. Volume II, Boston, Hilliard, Gray
and Company, 1835, p. xxiii.

Vol. 49, No. 1

MEDICAL SCHOOL SECTION

Hear Members of the Facitlfy. Jlimnii. Students, and
rriends oj ilie Medieal Sclwol:

At tlif l)eginning of a new year it is appropriate to
re\ie\v the l)asic guide lines provided for the program of
nu'chcal education at ^Laryland Pertinent historical refer-
ences are quoted helow.

"An Act for pro\iding a Medical College in the city or
precincts of Pualtimore for instruction of students in the
different hranches of medicine." — passed by the State Leg-
islature at Annapolis (ju December 18, 1807. stated:

"IT — l]e it enacted, by the Cjeneral Assembly of Mary-
land, that a college for the promotion of medical knowledge,
by the name of the College of Medicine of Maryland, be
established in the city or precincts of Baltimore, upon the
following fundamental princi])les. to wit: The said college
shall be founded and maintained forever upon a most lib-
eral plan, for the benefit of students of every country and
every religious denominati(tn, who shall be freely admitted
to e(|ual ])rivileges and advantages of education, and to
• ill the honors of the college, according to their merit, with-
out requiring or enforcing any religious or ci\il test, or
urging their attendance U]wn any ]iarticular plan of religi-
ous worshi]) or service: nor shall any preference be given
in choice of a president, professor, lecturer or other officer
of the said college, on account of his particular religious
profession, but regard shall be solely paid to his moral
character, and other necessary qualifications to till the
I)lace for which he shall l)e chosen."

*****

January, 1964

BULLETIX OF THE SCHOOL OF MEDICINE, UNU'ERSITY OF MARYLAND
Dean's Letter (Cont.)

An Act for providing a University in the city or precincts
of Baltimore, by the name of the University of Maryland,
passed the Legislatnre at Annapolis on December 29, 1812.
It stated:

"1. Be it enacted by the General Assembly of Maryland,
That the college for the promotion of medical knowledge,
by the name of the College of Medicine of Maryland, be
and the same is hereby authorized to constitute, appoint
and annex to itself the other three colleges or faculties, viz. :
The faculty of Di\'inity, the faculty of Law and the faculty
of the Arts and Sciences ; and that the four faculties or
colleges, thus united, shall be, and they are hereby, consti-
tuted an University by the name and vuider the title of
The University of Maryland."

The "Faculty Organization of the School of Medicine"
as developed by the faculty and approved by the University
Senate, the University President and the Board of Regents
of the University in 1956 states that : "The aims of the
School of Medicine are :

1. To select and educate students to be competent physi-
cians of the highest character, fully conscious of their
civic, social and professional responsibilities.

2. To advance medical knowledge by maintaining facili-
ties for supporting medical research and fostering
research by both faculty and students.

3. To provide medical educators for the future.

4. To conduct medical postgraduate and graduate edu-
cation to assist physicians and ancillary professional
and scientific personnel to improve their knowledge
and skill.

5. To assist in public education on matters pertaining
to health.

6. To advise the properly constituted authorities of the
State of Maryland concerning matters afTecting the
health of its citizens."

Sincerely,

William S. Stone, M.D.
Dean

Vol. 49, No. 1

Dean's Office Announces Promotions

A xuMBER of faculty meml)ers have
recently received promotion in the
School of Medicine.

Dr. Sheldon E. Greisman has been
promoted to the rank of Associate Pro-
fessor in the Department of Medicine.

A nati\e of Xew York City and a grad-
uate of the Xew York University College
of Medicine, Dr. Greisman served his
internship and residency in internal med-
icine at the Bellevue Hospital in New
York City. He was also an Instructor in
Clinical Medicine at the Xew York Uni-
versity College of Medicine.

After i)ostgraduate training in neuro-
psvchiatrv and a period of Army service,
he joined the School of Medicine in 1954
as an Instructor in Medicine. During the
next year he was consultant in infectious
diseases to Walter Reed Army Medical
Center.

Dr. Greisman is a member of the
American Board of Internal Medicine.
Alpha Omega Alpha Society, the Society
of Experimental Biology and Medicine,
the American Federation for Clinical Re-
search, and the American Society for
Clinical Investigation.

His principal interests relate to the
mechanism of fever in infectious diseases.

Martin Irwin Gold. M.D., has been
promoted to the rank of Associate Pro-
fessor in the Department of Anesthesi-
ology. Dr. Gold also serves as associate
anesthesiologist at the James Lawrence
Kernan Hospital and at the Mount
\\'ilson State Tuberculosis Hospital. He
is also consultant in anesthesiology to
the U.S. Public Health Service Hos-
pital.

Thomas Arnold Good, M.D..has been
promoted from Assistant Researcli Pro-

fessor in Pediatrics to Associate Research
Professor in Pediatrics. A member of
the staff of the School of Medicine since
1958, Dr. Good was the recipient of the
Ross Laboratories Pediatric Research
Award, which cited particularly his
studies of the interrelationship of the
liypothesis and connective tissue bio-
chemistry in collagen diseases.

James A. Lyon, Jr., M.D., has been
promoted from Assistant Professor of
Radiology and Instructor in Pediatrics
to Associate Professor of Radiology. He
has been a member of the faculty at the
University of Maryland since 1956,
where he came following a year of grad-
uate work and three years of residency
in Radiology at the L^niversity of Penn-
sylvania Graduate School of Aledicine
and Hospital. Dr. Lyon will direct the
School of X-ray Technology.

Dr. Moritz Michaelis, who received
his Ph.D. from the University of Wurz-
burg and came to the University of Mary-
land from the Biochemical Institute in
Stockholm, has been promoted to Asso-
ciate Professor of Biochemical Research.
Dr. Michaelis, the author of more than
40 papers, has also served at the Chem-
ical and Medico-Chemical Institutes of
Uppsala Laiiversity in Sweden ; the Car-
diff City Mental Hospital in Great Bri-
tain ; and McGill University in Montreal,
Canada.

Dr. James Eugene Robinson re-
ceived his master's degree and doctorate
from \\'ashington L'niversity. After six
years at Stanford Medical Center as re-
search associate in radiology and lec-
turer in biophysics, he joined the faculty
of the School of Medicine in 1961 as
Assistant Professor in Radiologv. Dr.

Jauiniry. 1^64

Bl'LLHTIX OF THE SCHOOL OF MFDICIXE. VMlliKSFI'V OF MARYLAM)

Rol)inson now heads a new section of
radiation physics and radiol)i()logy.

Donald A. \\'olfi:i.. M.D.. radiologist,
lias been promoted to Associate I'rofessor
of Radiology in the School of Medicine.
Since he joined the facnity in 195S, lie
has served as instructor and assistant
professor. From 1953 to 1955 he served
as medical officer in the U.S. Army. I )r.
\\'olfers principal interest has been in
vascular radiolog}'.

Dr. McCrumb Speaks Before
Library Group

Dr. Fred R. McCrumb, Director of
the Institute of International Medicine,
delivered an address entitled "Interna-
tional Health in American Foreign Pol-
icy," on the occasion of the 10th annual
meeting of the medical library group of
the Washington, D. C, area, which was
held at the School of Medicine on Octo-
ber 26, 1963. The meeting coincided with
the 150tli anniversary of the founding of
the first medical library at the School of
^Medicine and was arranged by Mrs. Ida
M. Robinson. lil)rarian of the Health
Sciences Library.

Dr. William S. Spicer, Jr., head of
the Division for Pulmonary Diseases, has
been appointed to the National Advisory
Committee on Community Air Pollution,
a body created in 1957 to advise the U. S.
Surgeon General on Public Health Ser-
vice policies, objectives, and accomplish-
ments relating to air pollution.

In line with his interest in air pollu-
tion. Governor Tawes has also a])pointed
Dr. Spicer to a five-member air pollution
control council which was created in
1963 by an act of the Maryland legisla-
ture, the council being charged with
maintaining a "reasonable degree of ]uir-
ity" of the air resources of the state.

Dr. Sa.mtkl p. P)KSS.man', Professor of
I'ediatric Research and Associate Pro-
fessor of Biochemistry, j^articipated in
two ])anels at the first Pan-American
Congress of Neurology, held in Lima,
Peru, on October 21 to 25. 1963.

Dr. Hessnian discussed the chemistry
of hepatic coma and the chemistry of
hereditarv diseases.

Dr. Fred R. McCrumb has been elect-
ed to membership in the American Epi-
demiological Society. Meml)ership is con-
ferred on those who have contril)uted at
a high level to the general field of epide-
miology.

Dr. Raymond K. Thompson, Asso-
ciate Professor of Neurological Surgery,
has been elected President-Elect of the
Neurosurgical Society of America.

Dr. Raymond C. V. Robinson, of
the Department of Dermatology in the
School of Medicine, served as counselor
to the Southern Medical Association,
representing the State of Maryland.

Dr. Harry M. Robinson, Jr., lectured
at the St. Vincent's Symposium, in
Worcester, Mass., in October, 1963. Dr.
Robinson was also a guest of the \\ est
Virginia Academy of Dermatology at its
meeting held in Wheeling, A\'. Xtx.

Betatron Advances

The new betatron, an intense radia-
tion source, has been completed and in-
stalled in the new Martha V. Fill)ert
b!adiation Center at the University Hos-
l)ita].

h^ifteen times more powerful than the
usual col)alt-60 source, the instrument is
now being calibrated and put through an
exacting and exhaustive series of tests.
According to Dr. John AI. Dennis, it is
ho])ed that the facility will become avail-
able for cancer therapv earlv in 1964.

Vol 49, No. 1

MEDICAL SCHOOL SECTION

Lectureships Consolidated

The School of Medicine is fortunate
in being able to present a number of
lectureshii)s, the expenses of whicli are
defrayed liy dedicated funds. These in-
clude the Julius Friedenwald Memorial
Lecture, the Phi Delta Epsilon Annual
Lecture, the Uhlenhuth Memorial Lec-
ture, the Pincoffs Lecture, and the Alice
Messinger Band Memorial Lecture.
Many of these have now been consoli-
dated into a single program, copies of
which can l)e obtained from the Dean's
office in the School of Medicine.

It is hoped that the Bulletin will
be able to present the 1964-65 program
well in advance. The importance of these
lectureships cannot be overestimated. We
are happy, therefore, to present the pro-
gram for the second half of the academic
year, beginning with the lecture on Jan-
uary 14, 1964. All the lectures will be
held in the Gordon \A'ils()n Mall of the
LTniversity Hospital.

January 14

"Detection and Management of Mal-
absorption Problems"

By Daniel S. Ellis, M.D.

Clinical Associate in Medicine. Har-
vard Medical School

February 1 1

"Cerebral Vascular Insufficiency"

By C. Miller F'isher, M.D.

Assistant Professor of Clinical AU'ii-
roloyy. Harvard iMedical School

(The Uhlenhuth Memorial Lectures.
si)onsored l)y Phi lieta Pi Frater-
nity.)

March 3

"Patliogenesis of Xepliritis with a Dis-
cussion of Management"

liy D.^vid p. E.-xrle. ALD.

Professor of Medicine. X^orthwestern
School of Medicine

March 25

"Blood Coagulation and Thrombosis"

By Oscar Ratnoff, M.D.

Professor of Medicine, Western Re-
serve Lniversity School of Medicine

(Alice Messenger Band Memorial
Lecture )

A])ril 7

"The Current .Status of Gastric Freez-
ing"

By Owen H. Wangensteen, M.D.

Professor and Chairman, Department
of Surgery, University of Minnesota
School of Medicine

(The Phi Delta Epsilon Annual Lec-
ture)

May 12

"Interferon: Current Status"
By Robert B. Warner. M.D.
Associate Professor of Microbiology,
Johns Hopkins School of Aledicine

Department of Dermatology

Dr. Willl\m Dunseath and Dr.
Harry M. Robinson, Jr.. have presented
an exhibit entitled "A Statistical Study
of the Chronic Cutaneous Lesions with
Occlusive Dressing Techniques," at the
recent meeting of the Southern Medical
Association in New Orleans. At the
same meeting. Dr. Eugene S. Bereston
read a paper entitled "The Sturges
\\>ber Syndrome." Dr. Francis A.
lu.LLS. at the same time, served as a
panelist on the Zola Cooper Panel Svm-
])osiunL

Other meml)ers of the dejxartment have
also been active. Dr. Raskin and Dr.
Robinson have completed the initial ])hase
of a study on Tolnaftate. a verv potent
toi)ical fungicide. The ])reliminary re-
])ort is .schedided to api)ear in the Journal
('j Ini'estigatii'c I^ernuitolot/y during the
month of b\'bruarv, 1964.

Jamiarv. 1Q64

pook i^ebietus;

Anatomy. A Regional Study of Human
Structure by E. Gardner, D. J. Gray, and
R. O'Raliilly. 1006 pp. 2nd edition. W. B.
Saunders Co., Philadelphia, 1963. $17.50.

The stated aims of this book are 1) to pro-
vide a textbook that is sufficiently brief for
the undergraduate medical and dental student
during the present shortened course in human
anatomy, 2) to provide information on living
anatomy and to stress the importance of the
relationship between srtucture and function,
and 3) particularly by the citation of relevant
references, to meet the needs of the more
advanced student and the postgraduate worker.
The authors have certainly achieved these
aims. This is undoubtedly one of the finer
textbooks of human anatomy to appear in re-
cent years. Its regional plan of organization
suits the book well for use in the majority' of
laboratory courses of anatomy. Following the
introductory chapters on General Anatomy,
the various parts (regions) may be taken up
in any desired order to suit a particular sched-
ule of dissection. Although this book is shorter
by several hundreds of pages than some of
the older textbooks of anatomy, a wealth of
information is included through the use of a
double column format and by the setting of
detailed descriptions and sections on surface
anatomy in smaller type.

The draftsmanship in the line drawings is
not of uniform high quality, but all of them
adequately demonstrate the salient features
of the region depicted and some portray 3-
dimensional relationships in a clear, compre-
hensible fashion through the use of clever
technique and ingenuity. The te.xt figures are
supplemented by a total of 67 well selected
radiographic plates.

Beginning or advanced students of anatomy,
alike, who wish to pursue certain areas of
study in greater detail are supplied not only
with lists of general references, but with foot-
noted references to special works numl)ering

30, 40. and 50 or more per chapter covering
both classical and recent papers.

The widely adopted terminology of the
Nomina Anatomica (1955) as amended in 1960
is used throughout and is anglicized wherever
possible. The authors have wisely dropped the
eponymous terminology which is less meaning-
ful to the student than descriptive terms, al-
though some of the more common eponyms are
included in a special glossary.

The principal changes in this second edition
are extensive revisions of the text and illus-
trative material. There are new illustrations
and some have been modified and enlarged. A
number of references have been deleted to make
room for newer ones.

The authors are to be congratulated upon
this fine new edition of their book — one which
well merits a place among our current stand-
ard textbooks of human anatomy.

V. E. K.

Illustrated Physiology by Ann B. McXaught,
M.D., Ph.D., Ch.D., Lecturer in Physiol-
ogy, University of Glasgow, and Robert
Callender, Medical Artist, Instructor of
Physiology, University of Glasgow. The
Williams and Wilkins Company. Balti-
more, Md., 1963, pp. 287. $6.75.

Designed as a visual aid for students in a
university physiology course who lacked a
background of mammalian anatomy, the authors
have compiled an atlas composed essentially
of profusely labeled, diagrammatic representa-
tions of important anatomical and anatomico
physiologic entities or pathways, principally
mammalian.

While directed to the attention of the college
student, the quality and excellency of the
drawings and the profuse labeling provide an
illustrated atlas of great diversity, making the
book useful as a general reference for anyone
interested in the biological sciences. The vol-

Vol. 49, No. 1

MEDICAL SCHOOL SECTION

umo miglit be i)articularly valuable as a desk
reference for a busy practitioner who seeks
to explain to a patient certain basic body
structures and mechanisms with reference to
the location of disfunction or the disease. The
book could well be a part of the working office
library of any physician, regardless of his
specialty. A useful and expanded index is
appended.

J. A. W.

Clinical Examinations in Neurology by

Members of the Sections of Neurology and
of Physiology of the Mayo Clinic and
Foundation, Rochester, Minn. 2nd ed. Pp.
296. W. B. Saunders Co., Philadelphia,
Pa. 1963.

There are now a number of books available
purporting to be guides to the clinical evalua-
tion of the neurological patient. Far from
being just another addition to this group, this
manual makes a genuine contribution to med-
ical literature. An adequate guide to the taking
of a comprehensive neurologic history is in-
cluded. In this section of the book discussions
of common presenting symptoms and guides to
their evaluation in the history are found.

Complete examination of cranial nerve func-
tion and a discussion of neuro-ophthalmology,
including interesting sections on the differential
diagnosis of nystagmus, may be found. Al-
though the standard chapters on the examina-
tion of motor and sensory function are present,
these chapters are outstanding for their clarity
and completeness. Specific examination of the
status of individual muscles and muscle groups
is one of the many excellent features of this
section. Tests of use in evaluation of pain in
upper and lower extremities are handled in
detail.

.\n area that is extremely confusing for most
medical stvidents, language and motor speech,
is most lucidly discussed, with many concrete
suggestions for the clinical evaluation of these
functions.

Although discussions of chemical, radiolog-
ical, and other laboratory aids to the diagnosis
of neurologic disease are to be found in abun-
dance, those sections of this book dealing with
these subjects are remarkable for their con-
ciseness, clarity, and completeness. A short
chapter on the use of electroencephalography
is to be found. Along with a presentation of
electromyograjihy, with a description of the

clinical usefulness and interpretation of electro-
myographs, nerve stimulation studies are sum-
marized in one of the most outstanding chap-
ters.

The anatomy and physiology of the nervous
system of use in understanding the rationale
behind the various examination procedures are
included in each chapter of this manual. Lib-
eral use of diagrams and charts further add to
the unusual clarity of presentation found in
Clinical Exaiiiinatidiis in Neurology.

Although much of the information about the
recording of results of a neurological examina-
tion pertains to the excellent printed forms in
use at the Mayo Clinic, sample forms and
sample tests are included with the book. These
may serve to stimulate the development of like
methods in other centers.

This manual is recommended without excep-
tion to advanced medical students and to house
staff and all others interested in the rational
approach to a complete neurological examina-
tion.

JvIarvix N. Goldsteix

Human Histology by Leslie B. Arey. Pp. 338.
Illustrated. Second edition. W. B. Saunders
Company, Philadelphia and London. 1963.

$7.50.

On opening this volume one is immediately
impressed that it has two unique features. First,
the presentation is in strict outline form. All
the material is arranged under heads and sub-
heads and presented in short crisp sentences
with key words and phrases italicized for em-
phasis. Second, and even more unusual for a
textbook of any type and particularly for a
textbook of histology, is the lack of pictures.
The illustrative material is arranged in a num-
ber of strategically placed plates and consists
entirely of schematic line drawings. A single
contrasting color is used to add clarity and to
emphasize particular cells or parts of cells.
These drawings, combined with a section at
the end of the discussion of each organ or
tissue which reviews its diagnostic features,
are intended to enable the student to identify
and study slide preparations. A short section
devoted to function as it relates to structure is
also ])resented at the end of each chajiter.

The material included is complete and con-
tains information derived from some of the
newer techni(|i:es, such as electron microscopy,
as well as from more conventional methods.

JaniKirv. l'J64

BULLETIX OF THE SCHOOL OF MEDICINE. UXIJ'ERSrfV OF MAKYLAXD

The style is clear and concise and the use of
italics is a valuable aid to the reader. The
limitations of the method of illustration which,
as is evident from the Preface, are obvious to
the author, do not seem to greatly limit the
value of the text. Beginning students in human
histology will find this a useful guide to the
understanding of microscopic anatomy, and
the more sophisticated will refer to it often
when seeking answers to questions concerning
normal structure.

floW.VRD M. WiSOTZKEV, M.D.

The House Phjsician's Handbook, 2nd ed.,
by C. Allan Birch, .M.D., F.R.C.P. Pp.
204. The Williams and Wilkins Co., Bal-
timore, U. S. Agents. $4.50.

This is a pocket manual, written as a guide
to the medical and legal duties of a house phy-
sician. It includes concise, clearly written guides
to clinical and laboratory, therapeutic and diag-
nostic procedures in routine use. Much infor-
mation necessary to have at one's fingertips
is presented, often by means of charts. Unusual
for a book of this type are the cultured style
and literary allusions found. A unique table of
medically useful phrases in French, German,
and Italian is also included. Although much of
the general advice in the introductory section
is down to earth and internationally useful, the
legal information is applicable primarily to
Britons.

The major portion of this book is obviously
without geographical limitations and would be
of great use especially to medical students and
junior house stafif members in any part of the
world.

^[aKVIX X. GOLDSTEIX

Aids to Clinical Pathology by M. G. Rinsler,
M.A., AI.D. 3rd ed. Pp. 206. The Williams
and Wilkins Co., Baltimore. 1963. $3.50.

This is a new addition to the well-known
Students' Aid Series. It is a pocket-sized, hard
bound summary of the basic information neces-
sary to the understanding of human pathological
physiology and of the laboratory as an aid in
the diagnosis of disease. The fields of infectious
diseases, hematology, and clinical chemistry are
lucidly reviewed, incorporating many of the
recent advances in these areas. The 15 tables
included greatly increase the clarity of presen-
tation of this material. This volume would

api)ear to be a limited Init useful addition to
the medical student's bookshelf.

M.\K\I.\ X. GoLDSTF.IX

Diseases of the Skin, 5th ed. by G. C.
Andrews, M.D., F.A.C.P., and A. X.
Domonkos, AI.D., F.A.C.P. Pp. 749. W. B.
Saunders Co., Philadelphia, Pa. 1963.

The authors indicate on the title page that
their textbook is designed for practitioners and
.-students. Cutaneous diseases are discussed in
a concise, straightforward, and not too dog-
matic manner. When possible, entities have
been grouped as to etiologic factors such as
various micro-organisms, metabolic or inher-
ited factors. Other conditions are grouped with
reference to type of tissue involved, i.e., chap-
ters on connective tissue, reticuloses, dermal
tumors, etc. However, a chapter on tropical
diseases, included in many dermatologic texts,
is missing. Tropical diseases are well handled
but disconnected under headings of Syphilis,
Yaws and Pinta, Diseases Due to Animal Para-
sites, and Diseases Due to Bacterial Infections.

Chapters on anatomy, pathology, and allergy
are probably not detailed and complete enough
to be of great value to dermatology trainees
or specialists. X'^evertheless, there is ample new
material included which makes the book valu-
able to those specializing in dermatology. Rela-
tively recently described entities are presented.
.Some examples are the following : angiokera-
toma corprois diffusum, phenylketonuria, malig-
nant reticulemic erythroderma, cyclic neutro-
1 enia, alopecia mucinosa, Hartnup disease, and
cytomegalic inclusion disease.

More detail on treatment is given than is
probably necessary for the average practitioner
and medical student. This is particularly true
in chapters on radiation therapy, ionizing radi-
ation, physical methods, and treatment of epi-
theliomata. The information serves as a guide
for dermatologists and residents and enhances
the value of the book even more for this group.

Latest therapeutic modalities are presented.
Little space is wasted on outmoded methods.
A few e.\ami)les of the newer medications in-
clude : Griseofulvin in fungus infections, plastic
occlusive dressing with local steroids in psori-
asis, and 5-iodo-2-deoxyuridine in herpetic den-
dritic keratitis. Suggested use of systemic
steroids in severe acne vulgaris, frowned upon
by some dermatologists, is defended by the
authors. The section concerned with dermatitis

/',;/. 49. Xo. 1

MEDICAL SCHOOL SECTION

due to drugs has been up-dated. Older prepara-
tions such as Napharsen, Guauacum, and
Santonin have been deleted. Among the addi-
tions to the list are methotrexate, Griseofulvin,
and zirconium.

Photographs included in the textbook are
excellent. Clinical pictures are often presented
with photomicrographs of the lesions. Unfor-
tunately, photographs are not used to the very
best advantage because there is no reference
to the figure in the printed text. In the case
of pyoderma gangrenosum, pictures appear on
the page preceding the discussion of the entity.
More detailed legends could enhance the value
of the already exceptional photographs. Pic-
tures in the chapter on parasites are helpful for
identification of vectors.

Most of the references listed in the bibliogra-
phies have been written in the past decade and
many of them in the past five years. Thus the
reader is directed to background material pro-
viding current concepts. Too frequently, how-
ever, references noted in the text are not in-
cluded in the bibliography. A few examples
are cited : Ellis on urticaria pigmentosa, Mor-
ris on pediculosis corporis, Barrack on mollus-
cum contagiosum.

The book is printed on good quality paper.
Double column format and appropriate use of
bold type facilitate reading.

In general the authors have presented a book
concerned with clinical dermatology. It is well
written, contains new and current material,
and is most useful to dermatologists, medical
students, and other practitioners with a cursory
interest in cutaneous diseases.

Joan Raskin, M.D.

An Atlas of Electrocardiography by Hugo
Roesler, M.D., F.A.C.P., and Evan
Fletcher, M.D., M.R.C.P. Pp. 700, with
400 fig. The Williams and Wilkins Co.,
Baltimore. U. S. Agents. 1963. $28.00.

The senior author, Hugo Roesler, has made
numerous significant contributions to the
knowledge of cardiovascular diseases, perhaps
e])itomized in this volume. He died while the
manuscript was being prepared for the pub-
lishers, the joint work being completed by the
associate author.

More than an atlas, this volume adequately
illustrates the authors' belief that a sound

knowledge of clinical electrocardiography is
best acquired by the critical analysis of numer-
ous tracings correlated with the clinical and
pathological data. Grouped into the usual sub-
divisions, 400 electrocardiograms are presented
with detailed discussions, consisting of a minute
analysis of each tracing, the electrocardio-
graphic interpretation, followed by the clinical
data and, in 136 cases, the postmortem findings.
A final paragraph correlates the preceding
data and amplifies the interpretation of the
tracings.

The presentation is clear and balanced
throughout, physiologic concepts being empha-
sized in the interpretations. While the tracings
are scalar, the vector approach is used for
analysis of the ventricular complex. Consider-
able stress is placed upon terminal QRS ab-
normalities in myocardial infarction, with peri-
infarction block being discussed in detail. The
sections on occlusive coronary artery disease
are extensive, in keeping with the importance
of the subject. The more significant varieties
of cardiac arrhythmias are illustrated, but the
interchangeable usage of atrioventricular dis-
sociation and complete atrioventricular block
is needlessly confusing (Figs. 379 and 384).
That unfortunate term, interference, is linked
with atrioventricular dissociation (Fig. 389),
but is not defined nor the circumstances of its
employment explained in the text. Since the
associated features of the clinical varieties of
A-V dissociation can be described in simple
terminology by an analysis of atrial impulses
in relation to normal or abnormal states of
refractoriness, the concept of interference is
superfluous and better dropped from the litera-
ture.

The organization of the book is good and it
is extremely well indexed. In a day when
medical texts are often too heavy to lift, this
700-page book is surprisingly light. In achiev-
ing this laudable end, the publisher has occa-
sionally sacrificed detail by reducing the size
of the illustrations, as in Fig. 132 where notch-
ing of the P waves is barely visible. However,
the fitting of the illustrations in close conjunc-
tion with the related text has added measurably
to ready comprehension of the material.

This book will serve those best who already
have some knowledge of electrocardiography
and who prefer a "self-teaching" book. It
should he in all departmental libraries.

:\Iakvin H. Davis, M.D.

January, l'Jfy4

ABSTRACTS

Immunological Studies with Group B Ar-
thropod-borne Viruses. I. Broadened
Neutralizing Antibody Spectrum In-
duced by Strain 17D Yellow Fever Vac-
cine in Subjects Previously Infected
with Japanese Encephalitis Virus —
C. L. Wisseman, Jr., B. H. Sweet, M.
Kitaoka, and T. Tamiya
Aincr. J. Trap. Med. & Hyg. 11:550, 1962
Tlie neutralizing antibody patterns evoked
for selected Group B arthropod-borne viruses
in response to inoculation with the living at-
tenuated 17D yellow fever vaccine were com-
liared in two groups of human subjects with
the following characteristics : (1) subjects with
no evidence of previous Group B arbor virus
infection, and (2) subjects w^ho had experi-
enced primarily natural Japanese encephalitis
virus infection some time prior to vaccination.
The previous experience with JE virus did not
alter the pattern of appearance of YF neutral-
izing antibodies, either in time of appearance
or in height of antibody titer. Nor did the
administration of the related YF virus signifi-
cantly alter the level of JE neutralizing anti-
bodies. However, subjects with prevaccination
JE antibodies developed antibodies that neu-
tralized chiefly dengue type 1 and West Nile
viruses in response to the 17D strain inocula-
tion, while subjects without prevaccination
Group B arbor virus antibodies did not.

Interaction of Rickettsiae and Phagocytic
Host Cells. III. Opsongizing Antibodies
in Human Subjects Infected with Viru-
lent or Attenuated Rickettsia prowa-
zekii or Inoculated with Killed Epi-
demic Typhus Vaccine — C. L. Wisseman,
Jr., J. R. Gould, and J. G. Wood
/. Immunol. 90:127, 1963

Infection of human subjects with virulent
or attenuated (Strain E) Rickctt.'iia proi^'uzckii
was followed within two weeks by the appear-
ance of antibodies which would enhance phago-
cytosis of homologous rickettsiae by mouse
peritoneal leukocytes. Although an injection
of conventional killed epidemic typhus vaccine
appeared to cause more rapid appearance of
antibodies (by the end of 1 week), the titers
attained at this time were low and, on the
average, did not increase significantly in later

of articles by
faculty and alumni ,

s])ecimens. Serum from all groups also en-
hanced phagocytosis of A', moo.s'cri. but for the
most part these antibodies occurred in lower
titers tiian the antibodies involved in the
opsonization of R. pniica^ck'ii. The cross-
reactions observed with the murine typhus
antigen tended to be lower relative to the
homologous reaction in the group which re-
ceived the living attenuated (E strain) vaccine
than in the other groups studied.

Antibodies and Clinical Relapse of Murine
Typhus Fever Following Early Chemo-
therapy— C. L. Wisseman, Jr., W. H.
Wood, Jr., A. R. Noriega, M. E. Jordan,
and D. J. Rill

.bin. Inf. .Med. 57:743, 1962

Treatment with chloramphenicol was initi-
ated early in the course of disease (two to
four days after onset) in three cases of murine
typhus fever acquired presumably through the
respiratory route. Chemotherapy was discon-
tinued 5, 8, and 10 days, respectively, after
onset. Clinical relapse occurred promptly in
each patient in less than two to about three
days after the last dose of antibiotic. In each
instance an array of anti-rickettsial antibodies
was present at the onset of relapse.

The very short interval between withdrawal
of drug and onset of relapse makes impractical
for murine typhus the same simple interrupted
schedule of chemotherapy that was developed
earlier for scrub typhus. As an alternative, a
regimen is proposed that might compensate for
the stage of disease at which treatment is
begun. This consists of daily administration
of antibiotic, at least until the patient has been
afebrile for 48 hours. Then daily therapy is
continued until the total time elapsed from
onset of disease is equal to about the mean
duration of the untreated disease, that is, until
about 12 to 14 days from onset.

The possible mechanisms by which clinical
relapse can occur in the face of appreciable
antibody levels are discussed. Among others,
the possibility is presented of the participation
of an inununopathological process in which
hypersensitivity and antigen-antibody com-
plexes contribute to the tissue damage in the
later stages of the disease.

J'ol. 49. No. 1

The Laboratory Animal and New Drugs^

JOHN C. KRANTZ, JR. and FREIDA G. RUDO

DiSKASE is the arch enemy of niankiiul.
It has Hniited and often curtailed his
every activity from the time lie dwelt in
cliffs to his occupancy of a modern sky
scraper. Man has ransacked the entire
earth to achieve a surcease from pain
and a \ ictorv over disease. The use of
drugs has plaved an im])()rtant role in
this conflict. Their value in disease
echoed out of the primeval jungle, when
a savage ai)plied the juice from a succu-
lent leaf to an arrow wound of the tiesh.
And today the struggle goes on, un-
ahated on all fronts in the lahoratory and
clinic in an effort to develop new drugs
in the conquest of disease.

To illustrate the importance of drugs
in the modern medical care program of
America, the following facts are striking.
The cost of the program is approximately
16 billion dollars annually. Of each dollar
25^ goes for physician's services and 20<j-
for drugs. The manufacture of drugs has
become a three billion dollar industry.
An avalanche of new drugs has descended
upon the medical profession and laity of
such magnitude that it affects every level
of physiologic organization from cells to
society.

The biologist observes that one of the
greatest marks of distinction between
man and other primates is that man
speaks. Sir William Osier observed that
another difference was that man liked
to take drugs. Indeed taking drugs has
l)ecome a favorite American pastime.
Each day, along with a host of other
drugs, the American public consumes 2)7

* A telecast over WMAR-TV, November 30, 1963—
Medicine 1963, sponsored by the Haltiniurc City Med-
ical Society.

tons of as])irin and nearh' one ton of
])hen()l)arl)ital. P)Ut why do ])eople take
drugs ? Most people want to do what they
want to do when they want to do it.
Disease and its symptom of pain stand
as a great ol)struction in their pathway.
People want to enjoy themselves un-
hami)ered by a headache, a stiff joint, or
a feeling of lassitude. And they believe,
and often times their belief is correct,
that they can achieve relief and a greater
degree of freedom to pursue their own
desires by taking drugs.

Most of the drugs that were available
to the medical profession up to a century
<-igo were naturally occurring plants and
minerals. ^Astute physicians achieved a
remarkable degree of success in the treat-
ment of the diseases of mankind by em-
ploying these natural products as medi-
cines. Indeed some of these are still in
current use and are very valual)le medica-
ments. The English Dr. \\'illiam Wither-
ing used digitalis, the leaves of the purple
fox glove, in the treatment of dropsical
conditions resulting from heart failure.
He used it first on a few turkeys, then
tried it on himself, and then on his dis-
tinguished patient Dr. Crawley. It was
fortunate, indeed, that he did not ]X)ison
himself or his patient. For without ade-
({uate testing on laboratory animals, it is
extremely hazardous to give a drug to a
human being. Withering was indeed for-
tunate to have been the disco\erer of this
\aluable drug that is still our most gen-
erally used remedy in the treatment of
heart failure. One hears his voice re-
sounding down through the decades from
1776 to today declaring. "\\'ith this drug

Januiirv. I"r)4

BULLETIN OF THE SCHOOL OF MEDICINE, UNIi'ERSITV OF ^LlRyL.^ND

we can regulate the pulse at will and to
the salutary ends for our patients."

Another example of the use of drugs
hefore the era of the lahoratory was that
of Dr. William T. G. Morton, a dentist,
who used ether hrst as a general anes-
thetic. Dr. Charles Jackson, a chemist,
gave Morton a sample of ether to ruh
on the gums of his ])atients in order to
ohtund dental pain. It was not satisfac-
tory and ]\lorton conceived of the idea
of the inhalation of the agent, which
he found produced unconsciousness and
complete olilivion to pain. He tried it first
in general surgery on a patient in the
Massachusetts General Hospital on Octo-
ber 16. 1846. Dr. J. C. Warren looked
up to the skeptical audience in the bal-
cony and exclaimed, "Gentlemen, this is
no humbug; Mr. Abbott is fast asleep."
And the era of general anesthesia was
established.

Medicine has tried always to extend
the number of drugs used in the treat-
ment of disease and increase their scope
to treat and cure other diseases. During
the last century the organic chemist has
synthesized more than a million new^
chemical compounds. These are new cre-
ations of matter which have never existed
on this planet before. Brilliant dyes, new
plastics, new and effective insecticides,
and new fabrics have been created. The
implication is abundantly clear, that a
new science was necessary to determine
the action of these new substances on liv-
ing systems, in order to ascertain whether
or not they might be useful as drugs in
the treatment of disease.

To meet this challenge, pharmacology,
with its array of laboratory animals, be-
came an established medical science at
the turn of the century. So important in
the development of new drugs is the lab-
oratory animal that without these labora-
tory test objects progress in new drug-

research would be absolutely halted. The
pharmacologist uses mice, rats, rabbits,
guinea pigs, cats, dogs, and monkeys to
test new chemical compounds. In the use
of these animals, he endeavors to ascer-
tain the answers to two fundamental
(|uestions :

1. Does the compound produce a re-
sponse on the animal that would be useful
in the treatment of disease in man ?

2. Can the compound be safely admin-
istered to man as a drug? Thus from his
experiments with animals, the pharma-
cologist can determine the nature and
the efficacy of the action of the compound
and also its relative safety. And safety
is so important, for all drugs have poten-
tial harmful effects and these nuist be
determined and weighed against the ben-
eficial or curative action of the drug.

But why does the pharmacologist use
such a wide variety of animals ? Through
the years he has learned that there exists
often a wide species variation between
the action of a drug on one kind of ani-
mal and its action on an animal of
another species. W'ith several species of
animals, the pharmacologist is able to
obtain a more faithful prediction of what
might be the expected action in man. For
after the completion of all laboratory
studies, the pharmacologist must extra-
polate and project the action of the drug
to man. This is difficult and requires skill
and judgment that is acquired only after
years of experience. Thus after comple-
tion of all the studies on the laboratory
animals, the final approbation or dis-
approbation of the drug is determined in
the clinic by careful observation on man
afflicted with the disease on which the
drug is indicated to have its effect.

The concept of a new drug stems from
the minds of the pharmacologist and
chemists. They must know the diseases
of mankind and the availability of drugs

Vol. 49, No. 1

KRANTZ & RUDO—THE LABORATORY ANIMAL AND NEW DRUGS

useful in their treatment or cure. Further-
more, it is a well-estabhshed fact that
there is no drug in use today that could
not l)e improved upon. Let us illustrate
this principle by an example from the
])harmacologic laboratory of the Univer-
sity of Maryland. Many of the generally
used anesthetics present explosive and
fire hazards. This is true of cyclopropane
and ether. Such explosions have caused
injury to many patients and others in the
operating room. Indeed they may very
often be fatal to the patient. Al)out ten
vears ago, we decided that by synthesiz-
ing a new ether with fluorine in the mole-
cule, we might diminish or even eliminate
the explosive hazard. Accordingly, we
])repared ether with 10 fluorine atoms in
the molecule instead of 10 hydrogen
atoms. Our prediction was correct ; the
new com])ound was completely devoid of
the explosive hazard. Actually it was an
excellent fire extinguisher. But what
about its anesthetic properties? On
mice, dogs, and monkeys this compound,
known as perfluorodiethyl ether, showed
no anesthetic properties. In fact, it was
as inert as the nitrogen of air we breathe.
We decided immediately to prepare
another ether, replacing only a portion
of the hydrogen in the molecule with
fluorine. This ether known now as
Fluoromar ( named after the University
of Maryland) was found to exhibit little
or no explosive hazard and also produced
anesthesia in mice. Through a period of
a year we studied this agent on the whole
s])ectrum of laboratory animals. More
than 200 anesthesias were conducted.
P>lood pressure, electrocardiograms, elec-
troencephalograms, blood tests, liver
function, and kidney function tests were
])erformed. Surgical operations were per-
formed on dogs to determine the degree
of relaxation and freedom from ])ain
])roduced bv anesthesia with Fluoromar.

All of the tests met our expectations, in-
dicating the possible use of Fluoromar
as an anesthetic in man. In these tests of
a new drug it is alnmdantly clear that the
laboratory animal is indispensaljle.

Armed with the information ol)tained
from the laboratory animal, ten years ago
one of us (J. C. K. ) anesthetized Dr.
Max Sadove of the I'niversity of Illinois
with Fluoromar for a period of 20 min-
utes. The anesthesia was smooth and the
recovery uneventful. That same after-
noon, Dr. Sadove, a distinguished anes-
thesiologist, anesthetized three patients
re([uiring surgery with Fluoromar. Fluo-
romar became available as an anesthetic ;
it was followed by other fluorine-contain-
ing anesthetics such as Fluothane and
methoxyflurane. It is now estimated that
approximately 15 million patients have
l)een anesthetized with these three fluo-
rine-bearing anesthetics, with the fire and
explosive hazard eliminated. Without the
laboratory animal this progress would
have been impossible.

Encouraged by this success we at-
tempted to improve on the molecule of
the anesthetic Fluoromar. Thus we in-
creased the number of fluorine atoms in
the molecule of Fluoromar from three to
six. A/Iuch to our amazement this com-
pound when tested on rats produced no
anesthesia, but violent convulsions. Again
one notes how fortunate it is that the
laboratory animal is the gate through
which a drug must pass before it is tested
on man in the clinic. All species of labora-
tory animals that inhaled this new fluori-
nated ether, now called Indoklon, con-
vulsed violently. The character of the
convulsion resembled that produced by
electroshock used in tlie treatment of
mentally ill ])atients. b'or manv months
Indoklon was tested repeatedlv on a
large \ariety of laboratory animals. It
ne\er failed to produce a convulsive

January, 1964

BULLETIX OF THE SCHOOL OF MFPICINE. UXirERSFf)- OF M.IRVLAM)

seizure. Aj^proximately 300 convulsions
were evoked in laboratory animals and
all available tests were conducted to de-
termine wbether or not tbe convulsive
seizure produced a banulul effect on the
animals. 'J'bese tests rexealed that the
seizure i)roduced no deleterious effects
on the animals. Man was to be the next
test sul)ject.

Six years ago one of us ( j. C. K. ) ad-
ministered Indokdon to four ])atients who
were mentally ill and for whom electro-
shock was indicated. The laboratory
animal results were duplicated in man.
During the ensuing years about 3.000
mentally ill jjatients have received the
treatment. It appears to enjoy a greater
patient acceptance than electroshock and.
in many cases where benefits from elec-
troshock are not achieved. Indoklon has
proved to be a valuable drug. Without
the laboratory animal, standing as it were
in the vanguard of progress, this treat-
ment could not have l)een established.

Many types of cancer can readily be
produced in the mouse and rat. The
workers in this most urgent field of re-
search test thousands of new compounds
each year for their capacity to check
cancerous growth and eradicate the dis-
ease. Some of these compounds showing
promise of success in mouse and rat can-
cer are then tried on man suff'ering with
cancer. Sticcess in the lal)oratorv animal
in this most difficult field of research has
not always been paralleled l)v a corre-
s])onding success in the treatment of
human cancer. But certain strides have

been made, for example, luethotrexate
in the treatment of leukemia and nitrogen
nuistard and its derivatives in the treat-
ment of solid tumors.

Certain laboratory animals, like the
monkey, lend themselves well for the
testing of new drugs that aft'ect the l)e-
havior of man. Thus, tranquilizing drugs
are tested on the Rhesus monkey. The
monkey retains his jungle characteristics
in captivity. He is siisf^icious, antagonistic
and even jcrocious when approached by
man. A new drug, if it is to be valuable
as a tranquilizer, will convert the jungle
behavior pattern into one of docility and
submissiveness. This is achieved without
rendering the animal unconscious.

Let us examine for a moment the
liealth record of the human race in whicli
the discovery of new drugs and the
lal)oratory animal have jdayed a vital
role. At the time of the Roman Empire
the life expectancy at birth was about 25
years. Wdien William McKinley sat in
the White House it had increased to 42
years. When John F. Keiuiedy served as
president, it had almost doubled, reaching
the gratifying expectancy of 71 years.

Health, like democracy, can never be
taken for granted. Eternal vigilance and
persistent effort in research are necessary
to add years to our lives and life to our
years. The search for new drugs to
achieve this end goes on at a sttipendous
pace, and in the vanguard of this progress
stands man's faithful allv — the laboratory
animal.

]'ol. 49. No. 1

OFFICERS

President

GiBsox J. Wei.ls. M.U.

President-Elect

J. Howard Franz. ^M.D.

Vice-Presidents

Louis Daly, M.D.
\"iNCENT Davis, M.D.
.\rciiie K. C'ohen, M.D.

Secretary

Frax;:is J. P.orgks. M.D.

Treasurer

Howard H. Mays. M.D.

Executive Director

Wii.i-iAM H. Trii'i.ett. M.D.

Executive Secretary

Mrs. I.diise ("iIrkin

Board of Directors

Theodore E. Woodward, M.D.
F. Ford Loker, M.D.
Nathan E. Needle, M.D.
Harold P. Biehl, M.D.
Rexnert M. Smelser, M.D.
Joseph D'Axtonio, M.D.
William Supik. M.D.
High McNally. M.D.
Emmaxuel Schiml'nek, M.D.
Fraxk K. Morris. M.D.

(cr-ofHcio)
George H. Veager. M.D.

(cx-officio)

Nominating Committee

Fraxk K. Morris. M.D.
George H. Yeager. M.D.
Harry Beck, M.D.
Louis C. Dobihal, M.D.
Joiix F. HoGAN, Jr., M.D.

Representatives to General
Alumni Council

F'rank K. Morris, >LD.
George H. Veager, M.D.
Wn.i.iAM H. Triplett, M.D.

Representatives, Editorial Board,

Bulletin

Harry M. Robinson, Jr., M.I).
JoHx F. Savage, ^LD.
C. Vernon W'illiamson, M.I).
Gibson J. Wells, M.D.
(c.r-officio)

Representatives, Advisory Board,
Faculty

Frank K. Morris, M.D.
George H. Yeager, M.D.

ALUMNI ASSOCIATION

SECTION

President's Letter

Fcllo-cc Medical . Uininii:

Tliis year of office as President of your Medical
Ahinini Association is passing all too quickly. There
seem to be so nianv aspects involved that one can not
help but worr}' if he i.s doing all that is possible. The
constant support and advice of Dr. William Triplett and
Dr. John Wagner does make one's job easier to perform
and the duties of the various committees are being exe-
cuted in such an efficient manner that the President ju:jt
can not express his gratitude too frequently.

The important event of this year is the combined
meeting on May 8, 1964, of the Medical Alumni Asso-
ciation and the various hospital groups in surgery,
medicine, obstetrics-gynecology and pediatrics. The com-
mittees involved in this undertaking have been working
very diligently to insure its success as nothing less than
outstanding. It is impossible to name them all, l)ut please
show your appreciation Ijy rewarding their efforts with
an enthusiastic and capacity attendance, and remember
this includes your wives.

Plans likewise are going forward for a Faculty-Alumni
Club for the Baltimore campus, and this will include
all the professional schools. This is a very long range
project in which Dr. Howard B. Mays has an intense
interest as our representative. He was one of the origi-
nators of this venture, which we all hope will be brought
to an early fruition. The club is a facility that is urgently
needed, and I hope will insure closer cooperation between
the Baltimore professional schools ; so much more can be
obtained through the combined efforts of these bodies.

Your treasurer. Dr. lloward Mays, has been most
determined in his efforts to bring our Alumni files and
record svstem to a liigh degree of accuracy. However,
this re(|uires the coo])eration of each member of the

JaiiitarY. 1964

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Medical Alumni Association. So please send to the office
all available information which is necessary and im-
portant to help complete and keep up to date this perti-
nent data. Your officers and Board are anxious to keep
improving your organization, so that each of you and
the School of Medicine may be justly proud. But re-
member we need your sincere and earnest cooperation
and constructive criticism to accomplish this goal.

At the present time our Medical School is in the fore-
front of progress — enlarging its properties and buildings,
investigating and promulgating new trends in medical
education and discovery. In this day and age it is neces-
sary to advance in the ever widening horizon of new
medical explorations and events, or fall by the wayside
and be left behind in the rapidly flowing stream of
medical progress.

However, there are moments when I must stop and
reflect that our School, which has always had the repu-
tation of preparing men and women to be good physi-
cians, must not stop turning out the doctor who is well
versed and trained in all aspects of medicine. I just can
not appreciate the cold scientific doctor who has lost
the human side of medical practice. To those who argue
I say to consider the example given us in medicine's
patron saint — Luke, the physician. Here is a man who
is worthy of every effort to emulate — kind to all, be he
Jew or Gentile, black or white, slave or freeman. He was
well educated and cultured, trained in the Greek method
to observe and evaluate in the most scientific manner pos-
sible, but above all a God-fearing practitioner of the art
of medicine, highly receptive at all times to the needs of
his patients. We should all pause to see how close each
of us has come to the example set for us by L.uke. the
physician.

I am certain that all of you will be happy to know
that Dr. Hugh R. Spencer, Emeritus Professor of
Pathology, has been selected as the recipient of the
Alumni Honor Award for 1964 and has accepted with
sincere appreciation and in all humility. I assure you he
most justly deserves this honor.

In closing, please remember May 8, 1964, the date for
our big annual meeting. Right now, decide to attend by
marking the date on your calendar and plan to bring
your wife. If each of you Medical Alumni will do this,
we will be assured of an unqualified success.

Gibson J. Wells, M.D.
President
n Vol. 49, No. 1

Important Notice!
Alumni Annual Meeting Date, May 8, 1964

Clianged to Conform with Hospital Groups

Ik a letter to all alumni. Dr. Edward
F. Cotter, Chairman of the Joint Com-
mittee on Arrangements, annoimced that
the annual meeting of the Medical Alum-
ni Association will he held on Friday,
May 8. 1964. Although early June has
been the traditional meeting time for
alumni, many have requested a change
because of inconvenience with gradua-
tion acti\ities and other medical meet-
ings.

In 1964 the meeting will he held on
the weekend of May 7-8-9 and will be
slightly different since the Medical
Alumni Association will join the depart-
mental associations of the University
Hosi)ital. which this year will include
programs in medicine, surgery, pedi-
atrics, gynecology, and obstetrics. It is
natural for the alumni to join with these
departmental associations since there
have been alreadv numerous successful
meetings of these organizations during
the month of ^lay, just preceding the
annual Alumni Association meeting.
Thus there will Ije papers and discussions
of interest for everyone as the scientific
])roceedings will cover many dift'erent
specialtv groups. In addition to renewing
friendshi])s, alumni reunions will again
be held for the so-called five-year classes
as well as specialty meetings for the
various groups of })hysicians who have
served in the I'niversity Hos])ital.

While details of the program will reach
each alumnus separately (and also in the
April, 1963, issue of the Bulletin; a
preliminary program shows activities be-
ginning on Thursday, May 7, in the
hospitality room of the Lord Baltimore
Hotel. The next day scientific meetings
will begin, after a talk of general interest
by a prominent speaker. Luncheon will
l)e held at the Student Union Building,
with a business meeting of the Medical
Alumni Association following. Dining
and dancing at the Alumni Banquet on
the same evening will round out a happy
and memorable day.

The departments of the medical school
and hospital will have Open House and
exhibits on May 9 and a small but inter-
esting scientific meeting is being arranged
as part of the 25th anniversary activity
of the Class of 1939. Dr. Raymond M.
Cunningham is chairman of this group.
A day of interesting activities is being
planned for the wives on Friday, May
8, through a committee headed by Mrs.
James G. Arnold.

Rememl)er, this year the Medical
Alumni Association's annual meeting
and the meeting of the clinical associa-
tions of the University Hospital will be
held simultaneously from May 7 through
Mav 9.

JdiuKirv. l'->()4

Dr. Hugh R. Spencer

Named Recipient of 1964

Honor Award and Gold Key

Hugh R. Spencer, M.D.

Dr. Hugh R. Spencer, Emeritus Pro-
fessor of Pathology in the School of
Aledicine, has heen named recipient of
the Alumni Association Honor Award
and Gold Key. A distinguished scholar.
])athologist, teacher, and advisor. Dr.
Spencer has materially influenced the
careers of several generations of alumni
of the School of Medicine. His contril)u-
tions have heen recorded in a previous
issue of the Bulletin of the School of
Medicine (Vol. 41, No. 2-April, 1952).

Instead of redocumenting the accom-
plishments of this honored faculty mem-
her, the Bulletin asked a member of
the alumni. Dr. Dexter R. Reimann of
the Class of 1939, to officially announce
tlie nomination of Dr. Spencer. His
article follows.

HUGH R. SPENCER
Honored Alumnus 1964

— A Tribute —

By Dexter R. Reimann

We edify ourselves when we exalt men
of great character, we dignify ourselves

v\hen we honor men to whom honor is
(Uie, we magnify ourselves when we pay
homage to the deserving. Is there one
of us who will not feel rewarded this year
when Dr. Hugh R. Spencer receives the
1964 Medical Alumni Association Honor
Award and Gold Key ?

14ie tenth day of May, ISSS. was un-
like other days in Jarrettsville, Md., be-
cause a baby, not yet named Hugh, was
l)orn to Rose /\nna and Clayton A. Spen-
cer. The days to follow were not the
same either for jarrettsville and the sur-
rounding county, as swaddling gave way
to stove-pipe pants, and baby l)ecame the
growing lioy, the hunter, and the archc-
ologist in search of Indian relics.

Hunting, especially raccoon, and In-
dian lore survived as major interests of
Dr. Spencer and, in fact, i)eriodically,
even in liis ])rofessional days, pushed
aside liis fruitful interest in pathology.
.Many of his trainees remember with de-
light how refreshing his accounts were
of cold nights ringing with bawls and
chops of prize hounds, and how exciting
his descriptions of the show-down fights

/•(-/. -/y. Xo. 1

ALUMNI .ISSOCI.ITION SECTION

l)etweeu hounds and coons. Others re-
nienil)er fondly his jMcturing of Indian
camp sites and l)urial grounds and his
excitement as he rehved the thrill of
discovery.

Through his hoxhood. ])r. Spencer
shared a hapjiy family life with sister
Mary and attended county schools. It
was here, in the security of a good home,
that the character which we admire he-
gan. A life close to the soil and nature
encouraged its dexelopment.

As adolescence hlended with adult-
hood, further education was sought at
the Baltimore Medical College on North
Howard Street. Here the doctor took
shape, the doctor who was to serve the
University so well for 4C) years.

Dr. Spencer liecame an alumnus in
1910 and set a course which led him into
a distinguished career in ])athology.

With appreciati\e eye for heauty,
charm, and character. Dr. Spencer pur-
sued Lillian Mlliott until she said "yes."
They were married on July 6, 1912. In
th.e years that followed, Mrs. Spencer
did more than live up to her husl)and"s
expectation for hy Dr. Spencer's own
admission, she was the hest housekeeper,
hest cook, best companion, and hest all-
around-girl living on this side of the sea
and century.

World events were soon to in\'olve the
L'nited States in war. Dr. Spencer was
not hesitant in his response to his coun-
try's call, so hy 1918 he was in France
serving as a ])<athol()gist with the First
Army.

Soon after Dr. .Spencer's return from
France he was made, in 1919, Professor
of Pathology at the University of Mary-
land School of Medicine. In this position
he won the admiration and friendship of
his students and fellow faculty members,
i i is devotion to medicine and the school
did nuich to adxance the stature of our

corner of the medical world. In the lean
years of the twenties and thirties, his
selfless labors contributed nmch not only
to the school's survival Init also toward
raising the standards and reputation of
our .School of Medicine. On tlu' Admis-
sions Committee, he guarded the front
door ; as advisor to the dean, he helped
keep our house in order ; and as the good
teacher he was, when students hnished,
he admonished them to do well by the
school and her r('i)Utation.

From 1925 to 1950 the name of II. K.
Spencer was to appear as author and
medical leader in local and national
journals. At home, where honor does not
come easily, a greater distinction was
won among all who knew him. To them
he was unexcelled gentleman, teacher,
friend, and loyal son of the University.

In 1956, after a career which deserves
emulation. Dr. Spencer retired. On the
occasion of his retirement. Spencer Day
Vvas arranged to do him honor and from
shore to shore of this nation, from border
to border, and from the Continent of
Kurope stuflents and friends came to pa_\-
homage. \\ here travel was not possible,
greetings were sent to wish him well and
sav thanks for your teaching and counsel.

Dr. Spencer's influence outlasted his
career and continues to spread its light
over medical students in many corners of
the land. A measure of his kindness, wis-
dom, and luedical knowledge now flow
through his many trainees who teach in
world famous schools to benefit future
doctors of medicine.

Well .should the present generation
know U])on whose shoulders they stand,
and thev should know that from Dr.
Spencer's shoulders they get an ins])iring
view.

If greatness and fame should survive
its own time, let the name of Spencer be
re])eated to future generations.

JcDiiiary, 1064

As We Approach Our 50th Anniversary

Ik another year, the Bulletin will
be 50 years old. As we approach this
important milestone, a review of the
past century during which this journal
has recorded the history of the School of
Medicine, and in part some of its scien-
tific achievements, two elements will im-
mediately become important and para-
mount. First will be the record of scien-
tific achievement as it has compared to
the stream of scientific development
throughout the world. Next, it is our
hope that the past half-century can again
be re-created or epitomized, perhaps as
an inspiration for the next half-century,
during which we hope the Bulletin will
continue to prosper.

Help from Alumni who have graduated
during the past half-century will be most
valuable, particularly from the historic
aspect which we hope to develop in some
detail. To this end, photographs, prop-
erly identified if possible, will be most
welcome as loans, or, if the donor de-
sires, as a gift to the school. After their
use in the Bulletin, they will be given
to the Dean's office for appropriate filing.

Alumni of the School of Medicine can
contril)ute also by means of historical
studies and by allowing us the use of
important documents which have come
their way.

Cooperation of each interested reader
of the Bulletin is respectfully solicited.

The Bulletin Does Get Around

This current issue of the Bulletin
numbers 2,900 copies. At first this does
not appear to be an impressive press run.
However, when compared to some of the

leading scientific journals of the country,
a favorable comparison is noted.

The Bulletin is not only distributed
to alumni, but has a wide circulation in
exchange, the library receiving valuable
journals from throughout the world —
api)roximately 600 such exchanges exist.
In addition, numerous subscriptions to
the Bulletin are enjoyed by non-alumni
subscribers.

The following table of comparison is
interesting.

As of
December

Journal 1962

Bulletin, School of Medicine 2,900

American Journal of Clinical Pathology 7,273
American Journal of Physical Medicine 1,359
America)! Journal of Tropical Medicine

& Hygiene 2,563

Angiology 2,081

Applied Microbiology 4,116

Gastroenterology 4,888

Journal of Bacteriology 9,848

Journal of Biological Cliemistry 6,151
Journal of Histocliemistry &

Cytochemistry 2,257

Journal of Immunology 3,199

Journal of Investigative Dermatology 2,580

Journal of Nervous & Mental Diseases 2,034
Journal of Pharmacology &

Experimental Therapeutics 2,433

Journal of I'rauuui 2,047

Journal of Urology 8,133

Laboratory Investigation 2,885

Medicine 3,841

Obstetrical & Gynecological Survey 6,607

Pharmacological Reviczcs 2,409

Plastic & Reconstructive Surgery 3,234

Stain Technology 2,775

Survey of Anesthesiology 3,759

Survey of Ophthalmology 1,850

Urological Survey 1,834

Vol. 49, No. 1

ALUMNI ASSOCIATION SECTION

Alumni Hold Meeting In
New Orleans

Alumni of the School of Medicine
were invited to a c()cl<tail ])arty and
l)uffet at the Royal Orleans Hotel on the
occasion of the annual meeting of the
Southern Medical Association in New-
Orleans. The party was arranged hy
Joseph Schenthal of the Class of 1^^39.

(lilson Wells. President of the Med-
ical Alumni Association, made a special
trip for the occasion and gave an illus-
trated talk on the progress heing made
on the Baltimore campus.

The party enjoyed a New Orleans
stvle huffet with wide variety of seafood
])rei)ared in the unique style of the area.
A New Orleans "comho" entertained the
group during the evening.

Those attending were :

Dr. & Mrs. L. C. Dobihal '20

Dr. & Mrs. F. A. Holden '20

Dr. Gibson J. Wells '36

Dr. & Mrs. Jos. Schenthal '39

Dr. & Mrs. Robert Shell '48

Dr. & Mrs. McGoogan '42

Dr. Elizabeth Sherrill "41

Dr. & Mrs. R. C. V. Robinson '40

Dr. J. Morris Reese '20

Dr. Eva F. Dodge '25

Dr. James A. Kelly '39

Dr. & Mrs. Conrad Richter '40

Dr. Arlie AIansberger '47

Dr. Louis Pratt '44

Mr. Marvin Saiontz "64

The next meeting of the Southern
Medical Association will he held in
Memphis. Tennessee, Novemher 16-19.
1964. No douht there will again be a
Marvland alumni gathering of members
of the Southern Medical Association and
their friends.

Lawrence F. Woolley Dies

Dr. Lawrence F. \\'oollky, who for
many years served as clinical director of
the Shei)pard and Enoch Pratt Hospital,
died in P)runswick, Ga.. on October 15,
1963.

A native of Salt Lake City and an
alumnus of the Johns Hopkins Univer-
sitv School of ^Medicine. Dr. ^^'oolley
interned at the I'niversity of Maryland,
to return to Baltimore at the Sheppard
and Enoch Pratt Hospital, where he was
appointed in 1932. During his tenure at
the Sheppard and Enoch Pratt Hospital,
he held an associate professorship in
Psychiatry at the School of Medicine and
was active in teaching during that period.
In 1945 he moved to Atlanta. Ga.. en-
gaged in private practice, and served as
a part-time instructor at Emory L'niver-
sitv.

Student Loan Fund Needs
Additional Growth

While a steady flow of contribu-
tions to the Medical Alumni Student
Loan Fund is acknowledged, the fund
cannot completely meet the demand. It is
urgent that interested Alumni contribute
to this rotating fund, which will be per-
]ietuated as the loans are repaid. Such
donations, tax exempt, meet a very
])ressing need in tlie School of Medicine
and are most appreciated bv the students
who loenefit through this interest and
Alumni irenerositv.

Jcuniarx. 1^64

NOTES

Elsewhere in this edition yoti will
find o "tear out" page, jar reporting
Alnnini Xews to the Bulletin. Tliis is
not 0)1 idle gesture.

]'oiir aehievenienfs. jcUow alumnus,
are of interest to your elassinates. They
constitute a reivard to the faculty, are a
challenge to the younger physicians, and
are an Item uj prestige for the Univer-
sity, release cooperate tvith us by for-
warding nezi's of yourself or a)iy alumnus
to the Bulletin. Thank you.

Class of 1916

Harry Goldmann has recently been
appointed as part time assistant in Psy-
chiatry at the School of Medicine.

At the 1963 meeting of the Academy
of Psychosomatic Medicine held in San
Francisco. Dr. Goldmann condncted a
workshop on "Psychotherapy and Hyp-
nosis in the Treatment of Obesity."

Dr. Goldmann recently changed his
address to 7121 Park Heights Ave., in
Baltimore.

Class of 1929

Jacob H. Conn ])articipated in the
1963 International Congress on Hypnosis
held in Xew York on October 26. He
presented a paper entitled "The Clinical
Aspects of Con.scionsness in Relation to
the Therapeutic Use of Hypnosis."

A jjast-president of the .Society for
Clinical and Experimental Hypnosis. Dr.
Conn serves also as a staff member of
The Johns Hopkins Hospital, The Seton
Institute, and Sinai I fospital.

He has been re-elected President of the
American lioard of Medical Hypnosis
and has been ap])ointc'd U.S. delegate
to the International Societv for Clinical
and Experimental Hypnosis.

Class of 1931

Mark B, Hollander has announced
tlie removal of his office for the practice
of Dermatology to 836 Park Ave., Balti-
more.

Class of 1933

Stephen Sewell has lieen appointed
chief of Gastroenterology at the Veterans
Administration Hospital, Lyons, N. J.
Dr. Sewell recently retired from private
practice in .Sjjring Lake. X. J.

Class of 1937

Eugene S. Bereston, Associate Pro-
fessor of Dermatology in the School of
Medicine, was a member of the Allergy
Panel at the annual meeting of the West
Virginia State Medical Society in
August, 1963.

Class of 1938

H. Leonard Warres has announced
the removal of his office for the practice
of Diagnostic Radiology to 3502 W.
Rogers Ave., in Baltimore.

Class of 1944

H. James Lambert, Jr., who for

eight years has been active in the practice
of Obstetrics and Gynecology at the
.Straub Clinic in Honolulu, has returned
to the mainland and has become asso-
ciated with Dr. James ^^^ Ravenscroft
in the practice of Obstetrics and Gyne-
cology with offices at 2330 First Ave.,
San Diego, Calif.

J 'ol. 49, No. 1

ALUMNI ASSOCIATION SECTION

Class of 1945

The \"ery Revereiul Edward Dhanis,
rector of the Pontihcrd Gregorian Uni-
Aersitv in Rome, has announced the ap-
pointment of Dr. Frank J. Ayd, Jr.,

to the Theology faculty. 13r. Ayd will
lecture on Psychiatry. He is the hrst
American lavman to teach at Gregorian
L'niversitv. which was founded as the
Roman College in 1551 hy St. Ignatius
Lovola and St. Francis Borgia. It is the
oldest ])ontihcal l^niversitv in Rome and
lias an international faculty and student
hody. Among its many departments are
faculties of theology, philosophy, canon
hiw, church history, and misseology and
Institutes of Social Sciences, ascetical
theology, and Latin literature. The major-
ity of the students are priests and semi-
narians, numhering some 3,360 from all
over the world.

Class of 1951

David Kipnis has heen named direc-
tor of a pediatric unit established l)y
A\'ashington University in the St. Louis
Children's Hospital as a part of the
school clinical research center. The new
unit is supported by funds from the Na-
tional Institutes of Health. Dr. Kipnis
serves as Associate Professor of Medi-
cine at the Washington LIniversity School
of Medicine in St. Louis.

Class of 1954

David Levy is currently serving as a
])()Stcl()Ctoral fellow in microbiology and
medicine in the Division of Immunology
at The Johns Hopkins Hosi)ital. Dr.
Levy was recently certified by the Amer-
ican Jjoard of Internal Medicine.

Joseph J. Noya has been certified l)y
the American Board of Surgery during
the year 1963.

Dr. Noya, a member of the regular
corps of the U. S. Public Health Service,
formerly served as Deputy Chief of
Surgery at the U.S. Public Service Hos-
])ital in New Orleans. At the same time
he served as Clinical Instructor in Sur-
gery at the LSU School of Medicine in
New Orleans.

Dr. Noya has been recently promoted
to Chief of Surgery at the U. S. Public
Health Service Hospital in Detroit,
Mich.

Robert R. R. Roberts, now on active
duty with the U. S. Navy, is currently
stationed at the \J. S. Naval Hospital at
Camp Lejeune, N. C.

Robert Yim of Lutherville, Md., re-
l^orts that in addition to his regular prac-
tice of Pediatrics, he finds time to serve
on the LTnited Appeal Committee and is
taking an active part in its work. He is
also serving as a lecturer in Pediatrics
at the School of Medicine and is active
in his local medical society, where he
serves as a committee member for the
Pediatric Annual Seminar. He is Clinical
Director of Child Hygiene for Baltimore
City.

Class of 1957
William A. Simmons has been dis-
charged recently from military service
after two years at the Key West Naval
Hospital. Dr. Simmons is now in the
])rivate practice of Obstetrics and Gyne-
cology with offices at 208 First National
P.ank Bldg., Canton 2, Ohio.

Landon C. Stout, Jr., has been ap-
pointed Assistant Professor of Medicine
at the University of Oklahoma Medical
Center. Dr. Stout currently resides at
800 N. E. 13th St., Oklahoma City, Okla.

Januiirx. I'^>h4

Class of 1958

Robert B. J. Mulvaney was recently
graduated from the School of Law of
Fordham University, X. Y. At present
Dr. ]\Iulvaney is serving a legal clerk-
ship with the firm of Steiner and Scha-
pira in Newark, N. J. Dr. ]\Iulvaney is
also serving as physician to the I'^ssex
County, N. J., Penitentiary and is chair-
man of the Social Welfare Committee
of the Essex County, X'. J., Medical
Societv.

Class of 1959

William James Ross Dunseath has

entered a partnership with Dr. John
Franklin Strahan in the practice of Der-
matology, with offices at Suite 403 La-
trohe Building, 2 E. Read St., in Balti-
more.

William E. Rhea has heen appointed
chief resident at the Children's Hospital
of the East Bay, Oakland, Calif. Dr.
Rhea, who served his internship at the
Providence Hospital in Washington,
D. C, has served his entire residency at
the California institution.

Herbert Ribner, who recently com-
pleted his training in Neurology, has
l)een named instructor in Neurology at
the New York Medical College. Dr. Rib-
ner has also begun the private practice
of Neurology.

Class of 1895

John McMullen, 5250 Watson St.,
N.W., \\'ashington, D. C, for many
years Assistant Surgeon General of the
U. S. Public Health Service, died on
April 28, 1963, at the age of 93.

Class of 1896

George Washington Mitchell of 2

W. University Pkwy., Baltimore, died
on May 22, 1963. Dr. Alitchell was 88.

Class of 1903

Charles R. Richardson of Bel Air,
i\Id., died February 15, 1963, at the age
of 85.

B. M. C. 1907

Adolph Flachs of 241 S. Arlington
Ave., East Orange, N. J-, <^^ied July 1,
1963. at the age of 78.

P & S 1908

Ernest E. Whipple of 196 Hamilton
Circle, Painted Post, N. Y., died on
March 27, 1963. Dr. ^^4^ipl)le was 79.

Class of 1961

Robert A. Fink was recently a visi-
tor to the campus. Dr. Fink is now in
his second clinical year in Neurosurgery
at the University of Chicago Hospitals
and Clinics. Dr. Fink plans a year of
research before assuming duties as senior
resident.

B. M. C. 1908

J. Leroy Wright of 612 Southmont
l\(l.. Pjaltimore. died Septeml)er 11, 1963.

Class of 1908

James K. Insley, Sr., of 3501 St.
Paul St., l^altimore, died May 2. 1963.
Dr. Inslev was 77 .

Vol. 49. No. 1

ALUMXI ASSOCIATION SECTIOX

B. M. C. 1909

John Henry Messier, a general prac-
titioner in Howard and Frederick coun-
ties for more than 53 years, died Decem-
l)er 2, at the \'indabonne Nursing Home
at Braddock Heights, after a short ill-
ness. He was 77.

A native of Carroll County, Dr. Mess-
ier has been in general practice in the
johnsville and Union Bridge area since
1910. During \\'orld \\"ar I he served as
llrst lieutenant in the Army Medical
Corps.

B. M. C. 1910

Harrison A. Pruitt of Anderson,
S. C. died March 10, 1963. Dr. Pruitt
Vv'as 75.

William L. Stone of 473 75th St.,
Brooklyn. X. Y.. died on May 11. 1963.
Dr. Stone was 80.

B. M. C. 1911

Louis Adelard Perras of 129 Ruth
Ave.. Xew Bedford, Mass., died on Mav
30, 1963, at the age of 76.

Class of 1912

Abraham Schapiro died in Se})tem-
ber, 1963. He was 72 years old.

A native of Philadelphia and a gradu-
ate of the Baltimore City College, Dr.
Schapiro received his degree from the
University of ^Maryland and then in-
terned at the Sinai Hospital and later at
the Epstein Tuberculosis Hospital.

Class of 1915

Edgar W. Lane, who for many years
practiced in the lUoomsburv area near
P]nlil)sburg, X. |.. died at the Morton
Plant Hospital. Clearwater. Vh\.. on

November 30, 1963, following a heart
attack.

Retired from active practice since
1952, Dr. Lane had made his home in
Clearwater, Fla.

F"ollowing his graduation from the
School of Medicine, he interned at the
Baltimore City Hospitals and later
served on the stafT of the Xew Jersey
Sanatorium for Chest Diseases. He then
returned to the northern part of Xew
jersey where he served on the medical
staff of the Warren Hospital, which in
1933 elected him chief of its medical
staff. In 1952 he was named to the emeri-
tus staff' of the hospital. Dr. Lane was
also active on the medical staff's of the
Easton (Pa.) hospitals.

Class of 1918

Joseph Lucien Brown of 314 Tur-
rentine Ave., Gadsden, Ala., died on
July 2, 1963, at the age of 71.

William B. Dalton of 4217 Hender-
son Rd., Greensboro, X'. C. died on
October \S, 1963, following an operation
for carcinoma of the throat.

Sherman Balch Forbes of 706

Franklin St., Tam])a, Fla., died on June
25, 1963. Dr. Forbes was 68.

Class of 1920

William F. Martin of 225 Haw-
thorne Lane, Charlotte, X. C, died on
April 18. 1963, at the age of 65.

Class of 1922

H. Raymond Peters, Professor of
Clinical Medicine in the School of Med-
icine and ])rominent hematologist, died
on June 1 1, 1963, at the age of 66.

Long active as a senior member of the
medical staff at the ^lercy Hospit.al. Dr.

.hvniarv, 1^64

BULLETIX OF THE SCHOOL OF MEDICINE, UNirERSITV OF MARY LAX I)

Peters was widely known for his Inie
clinical studies during the early stages
of the development of knowledge con-
cerning: erythroblastosis.

Class of 1936

Philip L. Franklin

died recently.

of Gary. Ind.,

Class of 1938

Leonard C. Molofsky of 280 W.

Alac Arthur BKd., Oakland, Calif., died
on Ai)ril 30. 1963. at the age of 48.

Alvan A. Welfeld suffered a tragic
death recently in a fire which consumed
his garage at his summer home near Bal-
timore.

Class of 1939

Alvin Meyer of 117 E. 37th St.. in
New York City died on July 8, 1963. Dr.
Meyer was 47.

Class of 1941

Henry Robert Spinnler of Butler,
ark, N. J., died on April 25, 1963, at the N. J., died June 4, 1963. Dr. Spinnler
aee of 54. was 48.

Class of 1929

William Paul Dailey of Harrisbur^
Pa., died recently.

Class of 1931

W. O. Rehmeyer of \\\ard County
]\ronahaus. Texas, died July 15, 1963.

Class of 1934

Isaac Gutman, Associate in Ortho-
pedic Surgery at the School of Medicine,
died suddenly on November 29, 1963.

Jacob Herbert Rabinowitz of New-

Vol. 49. \o. 1

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ALUMNI NEWS REPORT

TO THE BULLETIN:

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SUGGESTIONS FOR NEWS ITEMS

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Address

Class .

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Bulletin — School of Medicine
University of Maryland
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Baltimore 1, Md.

BULLETIN School of Medicine
University of Maryland

VOLUME 49 APRIL, 1964 NUMBER 2

TABLE OF CONTENTS

PAGE

ORIGINAL ARTICLES

Psychogalvanic Skin Response Gustometry 22

Steven J. Borsanyi, M.D., Jose Quinones, B.S., and
Cyrus L. Blanchard, M.D.

Puberty and Gynecology in the Cuna Indians 25

Major Archibald W. McFadden, MC, USA

MEDICAL SCHOOL SECTION

Dean's Letter _ i

Appointments and Promotions ii

Grants iii

Publications of the StafF of the School of Medicine iv

Obituaries xviii

Book Reviews _ XX

Abstracts .__._ xxii

ALUMNI ASSOCIATION SECTION

President's Letter _ xxiii

Medical Alumni Annual Meeting Combined with Maryland Medical Reunion „ _.. xxv

Medical and Chirurgical Faculty Annual Meeting , _ _ „ xxix

Washington, D. C, Alumni Organize _ _ „ xxix

Class of 1939 Plans Program for Alumni Day xxx

Class Notes . _ xxxi

Deaths „ xxxiii

Alumni News Report ^ _ xxxv

-i/TfY. 1Q64 21

Psvcliojjijalvailic Skin Response Giislonielry

STEVEN J. BORSANYI, M.D., JOSE QUINONES, B.S., and CYRUS L. BLANCHARD, M.D.

'rill-; MKDK (ii.i-CAi. ASl'i'C'is of ai^cusi.'i of (lisa^rcciiicnt Ix'iii;^ tlic- tccliiiiiim- of

ri'(|uirc a ti-sliiiL; iiK'tlio<l lor tlic cxalii- ,L;ustator\' cxaininatioii. 'I lie most com-

atioii of tlu' ]i(Ti|)lu'ral taste apparatus moii method of lestiiij^ is the use of sohi-

whieh is accurate and ohjecti\c. lU'Cause tions which icpreseut the I'our hasic taste

of the recent upsurge in ear surjjjerw (pialities. Two common errors found

damage to the chorda t\'mpaui hecanu' with the use of this method are: ( 1 ) the

rather common, l)Ut it is weh tolerated use ol solutions of too hi,i;h concentra-

h\' the majoritN' ol patients. I iowever, tion. This ma\ lead not onl\- to an efiect

occasionalK' the loss of taste following;' on the taste huds hut also on the receptors

ear sur_i;er\- is se\erel\- com])lained of ol common sensihilit\ of the tongue

and it is not uulikeh' that compensation lhereh\- afiectiu}^ hoth the 5th and 7th

might he sought for it through legal cranial nerves. (2) The use of too much

procedures in these suit-conscious da\s. lluid for tln' examination. Chemical solu-

The cliief nerves of taste are the chorda tions diffuse rapidly throughout the

tym])aui which su])plies the anterior two- mouth, making localized testing dinicult.

thirds of the tongue and the glosso- ( )f agents other than chemical which

]iharyngeal nerve which supplies the are ca])ahle of e\-oking a sensation of

posterior one-third. It is (|uestional)le taste, hy far the most etTectix'e is the

whether taste fihers follow any other electrical current. The fact that passing

pathway hesides the chorda t\nipaui an electric current through the tongue

from the anterior ])ortion of the tongue. gi\cs rise to taste sensation was demon-

The ner\e most fre(|uently indicated as strated lirst hy X'olta in 1792. The cur-

an alternate ])athwav is the trigeminal rent exokes an acid taste when the elec-

nerve. I iowever, this nerve according trode on the tongue is the anode, and

to present knowledge is thought of as a an alkaline taste when it is the cathode,

mediator of common .sensihility (touch. The hrst attem])ts of (piantitative

jjressure. and temperature) and it does measurement of taste while ])assing a

not contain taste fihers. Cu.shing oh- direct current through the tongue were

served that removal of the (lasserian made in l'^55. I Iowever. tln' results were

ganglion did not cause any ])ermanent unreliahle hecause the electrical circuits

loss of ta.ste.' did not take into account the xariahle

\\'idelv \ar\ing results ha\'e heen oh- hody resistance hetween electrodes,
tained hy different investigators testing Kraru]) sohed this prohlem hy devising
for taste fmalh' with the estahlishmeni an apparatus which consists of a dry
of the chorda tym])ani and the glosso- hattery and a xariahle resistor and a
])haryngeal nerve as the main ])ath\vays potentiometer. I)y means of the poten-
for taste sensation, the only other cause tiometer the xoltage and therefore the
amperage can he regnlatcfl. Krarui)

From the Division of Otolarviifinloyv, .School of . , .' . . -11

Medicine. University of M.ii yl.n..I, H.iltimore. loUlld lU lllS .SCriCS ol 140 Uomial Suh-

22 J-ol. 40. No. 2

liOKS.LWI 1:1 .11.. r'>y( ll')(,.\l.l'ANIC SKIh' RRSPONSV. CJJSKjM 1:1 1'V

\ IV. I I hi- [laticnt in r<-arfy for th»- tfxt.

jccts that only 2/4 coiiM not vcco'^u'vac
a stimulus of 3rX) microarnpf-rfs. 'I'liis
stimulus is consirlcn-d lar^c ciiouj^li to
indicate total aj((rusia and at the same
time small cnouj^h Uy j^revent stimula-
tion rjf the 5th nerve, since out of 55
patients with totally severed chorrlas
only one lia^l any sensation of taste helow
?)()() micrfmmperes.-' '"'

In search for ati objective way of
testinj^ tastf the tfclinif|iu- dcsrrihf-d
above is heinjj used by us in cf^nibinatirm
with the psychfigalvam'c skin response
iiiftbr.d ( I'GSR ). The I'fiSk consists of
a decrease in the electrical resistance of
the skin to a vvifle variety ai stimuli. It
is an autonomic response mediated
tlirfiUj^h chanj^es in the secretory activity
of the sweat j(lands in the skin. This
reflex hai been used successfully in
physioloj^y. psycholrj^y, etc., aiul is of
particular interest io TJtolaryngolo^y in
aiulionietry' and olfactrjmetry,''

Method: The subject tinder investi-
gation is placerl iti a c)uiet rrjom and
blinrlfolded to eliminate extranerjus .stim-
uli. Then the I'GSk recf>rdinj( leads are
plarefj on the palmar surfaces of the
.secr^nd and ffMirth fingers of the left hand
anrl tlie grounrl is attached to the arm.
The l'<^i.SK .shock electrrnles are attached
to the rij^ht forearm. The cathode of the
{(ustometer is attached to the rij^ht wrist,
the anode is lieUl in the right hand, arul
placerl (m the tongue wlieti the experi-
ment starts C I'"ig. 1 ;.

The gtistometer is .set to deliver a
stimulus from 150 tf* 2'^X) microamperes.
This is cr>nsirlered above the threshfjld
value fr,r trK>st of tlie normal populatif>n.
The cf>nrlitioning (A the i>atient is car-
ried out by giving taste aufl shfKrk stimuli
simult;meously ai>f)roximately 10 to 12
times during a period of one miimte.
Then taste stimulus is given alone. If a
positive re.sfxjn.se i.s obtained, it is car-

April, V/(A

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

.^..^jKjv^jxiAA.

Fig. 2. Positive tracing.

Fig. 3. Negative tracing.

ried to extinction then reinforced. If no
response is obtained, the taste stimulus
is increased to maximum and the test
repeated.

To rule out the possibility that the
positive PGSR responses were actually
artefacts caused by the stimulating direct
current from the gustometer, the laten-
cies of the artefacts were measured by
computer averaging method. We found
that it took 200 milliseconds for the taste
stimulating current to travel from the
tongue to the recording leads of the
PGSR machine. On the other hand, the
average latencies of the PGSR responses
were in the 800 to 1 500 millisecond range,
thus ruling out the possibility of the
stimulus artefacts interfering with the
PGSR response.

Fig. 2 illustrates a positive response.
The first part of the tracing represents
conditioning ( a ) followed by the taste
stimulating current's artefact (b) and
by a positive PGSR response (c).

The next illustration (Fig. 3) is a
record of a negative PSGR response.
The conditioning part of the tracing ( a )
is followed by two taste stimulus arte-
facts (b) but no PGSR response.

Twelve patients with severed chordas
due to radical mastoid oi)eration were
tested in this series. None of the ])a-
tients in this group gave positive PGSR

response to galvanic taste stimulation
within a period of 3 months following
surgery. The control group consisted of
six normal subjects. The presence of
taste was readily determined in all of
the subjects from the control group with
PGSR electrogustometric method.

The main purpose of this preliminary
report is to focus attention on this new
method for testing taste. We feel that
PGSR electrogustometry is a reliable
method and may be of value in the field
of Otoneurology for the objective assess-
ment of the function of the chorda tym-
pani and in some cases, indirectly, of the
facial nerve.

References

1. CusHiNGS, H. : Tumors of the Nervous
Acousficus and the Syndrome of the Cerebello-
pontine Angle. W. B. Saunders Co.. Philadel-
phia, 1919.

2. Krarup, B. : Electrogustometry, A Metii-
od for Clinical Taste Examination. A eta
Otolaryni/. (.Stockholm), 49:294. 1958.

3. Krarup, B. : On the Technique of Gusta-
tory Examinations. Acta Otolaryng. ( Stock-
liolm) Suppl. 140:195, 1959.

4. Bordlev, J. E. and Hardy, W. C. : A
.Study in Objective Audiometry with tiie Use
of the Psychogalvanic .Skin Response. .Inn.
Otol.. 58:751, 1949.

5. Borsaxvi, S. J. and Bi.axchard, C. L. :
Psychogalvanic Skin Response Olfactometry.
Ann. Otol.. 71:213, 1962.

I'ol. 40, No. 2

Puberty and Gynecology in the Cuna Indians

MAJOR ARCHIBALD W. McFADDEN, M.C., U.S.A.

Traditional Medical and
Ceremonial Practices of the
San Bias Cunas of Panama

The beliefs and rituals centering
on the female in this primitive society
are an important part of their folk med-
icine. This elaljorate unscientific medical
system, hrml}- rooted in their ancient
religion, remains the closely guarded
knowledge of their medical practitioners.
The trihal life of these people, somewhat
altered during the past 450 years of
European predominance in Panama, is
now rapidly changing under the impact
of modern civilization. Their indigenous
system of medicine is also beginning to
crumlile ; however, conservatism, isola-
tion, and limited medical facilities have
prevented scientific medicine from re-
l)lacing traditional practices.

Their concepts of creation and human
reproduction arise from the heart of the
ancient Cuna religion, which Keeler^
considers a form of the once iniiversal
Earthmother religion. The most sacred
ceremony is the Inna feast for the newly
marriageable female, which symbolically
relates the events of conception, fetal
development, and childbirth. Their tra-
ditional lore is transmitted by lengthy
chants sung in an obscure symbolic vo-
cabulary, which only the priests and heal-
ers fully imderstand.

This system, which incorporates ele-
ments of religion, sympathetic magic,
superstition, and sound i)ractical therapy,
presents some curious parallels to mod-

Chief of Dermatology Section, Medical Service,
U. S. Army Hospital, Fort Jackson, S. C.

ern medical practice. An investigation of
Cuna medical lore indicated that the
area of obstetrics, gynecology, and pub-
erty rites was the least modified and
])robably the best example of their med-
ical heritage. Therefore, this account of
contemporary Cuna Indian medicine and
ceremonies is presented as a fragment of
an ancient American culture surviving
into the twentieth century.

STUDY METHODS

This account is based on information
collected from medicine men, diviners,
and chanters with the assistance of sev-
eral educated native missionaries. With
a letter of permission from the Panaman-
ian Government and the cooperation of
several prominent chiefs, I visited most
of the San Bias villages with a traveling
medical clinic between 1959 and 1961.
During these trips, I was able to observe
the ceremonies described in this paper.
Olowitinappi, a respected medicine man
from Mulatuppu, San Bias, came to my
quarters in the Canal Zone to spend ten
days teaching uses of herbal remedies,
therapeutic chants, and medicine draw-
ings.

The publications of Nordenskiod,-
Keeler,-' and Stouf* supplied detailed in-
formation on Cuna history and culture.
In spite of the distortions and omissions,
which resulted from the difficulties of
translation and the reluctance of the
medicine men to divulge sacred knowl-
edge, this account is considered reason-
ably accurate. The information in draft
form was sent to Saikla Ikwaniktipippi,
First Chief of Ailigandi and the leading

.April. 1^^(^4

ini.iJirix OF Tim school of mf.pioixf. rxiii-h'SFD' of .\LiRyL.L\n

authoritv on Cuna tra(litit)nal lore, lor
his approval.

TIIF. CUXA IXniAXS OF SAX BLAS

The Cuna Indians are descendants of
the people who dominated a large area
of Panama and Colomhia prior to the
Spanish Conquest. Today, they are con-
centrated in small villages along the
Carihhean Coast, east of the Panama
Canal. This region, known as the San
Bias Coast after a prominent point of
land and mountain range, has remarkable
natural beauty. A multitude of coral
islands are strung in chains among the
ofY-shore reefs. The brilliant greens and
blues of the almost transparent Carib-
bean contrast with the white beaches and
coconut palms of the islands. On the
mainland, the dense jvnigle. rising quick-
ly from the narrow coastal plain into the
mountains, is broken only by scattered
clearings. This country, in the shadow
of the Panama Canal, with no roads, few-
trails, and limited trade, has remained
almost unchanged since the time of
Columbus.

The Cuna Indians follow their tradi-
tional way of life, governed under a
form of town council with elected village
chiefs. They have preserved their tribal
identity, language, and a great part of
their ancient culture through a strict pol-
icy of isolation from foreign influences.
They depend on farming small fields by
the primitive "slash-and-burn" method,
fishing, and hunting for their main food
supply. They raise coconuts and av-
acados for sale to coastal trading boats
and receive money, cloth, tools, and
sugar in return. Many of the young men
work in the cities and the Canal Zone
for several years before settling down
in their home villages.

The typical island village is small.

densc'K' ])oi)ulated with lillle ui)en space
except the beaches, and located close to
a little river on the mainland. Their large
cane and thatch houses are built close
together along streets ; each house shel-
ters several generations related along
maternal lines : however, the eldest male
is the head of the household.

MEnitAL COXCEPTS AXI) I'K.KCTITIOXEKS

In the Cuna system of medicine, dis-
ease is caused by evil spirits attacking
the patient's soul. A host of supernatural
creatures, evil spirits, and demons of
disease, many with animal form and
attributes, wait in the darkness of night
or in giant trees and rocks to prey on
humans. These demons vary widely in
appearance and evil power ; some are tiny
like gnats with little influence : the worst
are hideous monsters with unlimited
capacity for evil.

The total soul of man is composed of
many individual souls, each belonging to
a separate region of the l)od\', and each
subject to injury from different demons.
A serious illness develops when demons
steal the total soul and carry it deep into
the eight levels of the underworld. Un-
less the medicine man can locate the
captive soul and compel the demon to re-
store it, the patient will die. Lesser ill-
ness and chronic disease result from
injury or theft of individual souls. Even
though many common diseases are recog-
nized and named, each symptom is at-
tributed to a specific evil spirit. Certain
diseases are considered to have both a
natural and a supernatural causation.

The medical practitioners function in
the role of priest-])hysician. There is
considerable specialization within this
.system, which is based primarily on
knowledge and confers a distinctive title
on the practitioner.

Vol. 49, No. 2

McFADDEX—PUBERTY AND GYNECOLOGY IN THE CUNA INDIANS

The A^clc (diviner) is born with super-
natural powers to sent his soul into the
underworlds to speak with demons and
devils and to see into the past and the
future. As a diagnostician, he may be
consulted in difficult cases ; however,
theraj)}- is reserved for the medicine man.
All other practitioners learn their trade
during manv vears of apprenticeship and
study.

The KaHtitlc, high priest and chanter,
manages the ceremonial Inna celebration.
He sings the sacred chants of reproduc-
tion and development for the "coming
out" party. These chants and rituals pro-
tect the new debutante from various
harmful influences. He does not practice
medicine unless he also is trained as a
medicine man.

The Inatnlet (medicine man), general
practitioner or specialist, studies under
several experienced inatulets for eight
to twelve years. He frequently takes spe-
cial training in diseases of the female,
but does not limit his practice. He treats
the patient with various medicinal tonics,
baths, and therapeutic chants with in-
cense. He relies on the ncle for the diag-
nosis and treatment of choice in difficult
and puzzling cases. His knowledge can
be learned without supernatural abilities.

Much of the knowledge and functions
of the inatulet can he only vaguely fitted
into the structure of modern medicine
under the categories of public healtli and
social work. There are numerous reg-
imens with therapeutic tonics, baths, and
chants which will enlarge a girl's natural
abilities as a hammock weaver, seam-
stress, and other skills wliich will make
her a better wife. Certain treatments are
intended to increase feminine modesty
or curb a tendency to sexual experimen-
tation outside of marriage.

PUBERTY CEREMONY

Menarche is observed with a ceremony
of seclusion and ])urification. This pub-
erty rite was instituted by the great cul-
tural hero, Ipeorkun, according to Cuna
legends.^' ^ It is a time of celebration
without ritual dancing or chanting. The
proud i)arents hold "open house" and
serve a sweetened cacao l^ean drink to
friends who visit to offer congratulations.
Only the "saptur ritual" is sacred and
forbidden to outsiders.

At the onset of the first menses, the
parents notify their neighljors and the
town chiefs. The young men prepare a
])alm leaf enclosure around a low platform
on the floor of the family house. The girl
remains seated on the platform, ac-
companied by village matrons and mid-
wives, for five day of ritual bathing.
These women, "who know the way of
bathing the maiden." assisted by friends,
pour sea water from a canoe over her
nude body during the day. She is allowed
food and drink only after dark. In some
villages the young men participate in
this ritual cleansing ; probably a survival
of an older tradition.

Inuring this seclusion, the girl is in-
structed in proper behavior and the im-
portance of her new status. She also re-
ceives some information of the secrets of
menstruation, but no detailed instruction
in sexual activity or her role in reproduc-
tion.

On the fifth day, the girl's whole body
is stained a deep black with the juice of
the sacred "saptur," the fruit of Genipa
Americana. The juice stains the stratum
corneum and requires about 10 days to
wear ofi^. This stain, in addition to mark-
ing the girl's new status as a young
woman (yakwa), is also a potent pro-
tection against the demons of disease.
The ceremonial painting com])letes the

April, 1964

puberty celebration ; it is a public an-
nouncement of tbe close of cbildbood.
The voung woman will usually be mar-
ried in three or four years.

The Sapttir Ritual: The sacred fruit
is collected in the mountains by a certain
official, "one who knows the way of the
saptur,"' with specified chants and cacao
bean incense. He sings of the origin of
the saptur and assisted by incense he
informs the plant spirit of his intentions.
He then climbs the tree in a circular
maimer and gathers fruit from each of
the four cardinal directions. Since this
is the only time that saptur can be picked,
and it is an important ingredient of
medicines and cosmetics, a large supply
nnist be collected. The fruit is carried
back to the island by the young men of
the village with shouting and singing. A
modern introduction is a shotgun blast,
which warns the people not to look at
the saptur being carried to the girl's
house. At the house this official cuts
four saptur fruit in half without looking
by a single blow of a machete. This
most sacred part of the ritual is barred
to all outsiders and to those Indians who
have abandoned the ancient ways.

Omens: Omens can be read in the
character of the cut fruit. Unequal sec-
tions, depending on whether to right or
left, may foretell an early death or mar-
ital discord. The presence of black specks
or strings indicates a lack of modesty
or premarital sexual activities. The girl's
future in marriage may read in the be-
havior of a female and male land crab
placed together in a basket. An aggres-
sive male crab foretells a brave and
dominant husband, while a vigorous fe-
male foretells a disagreeable, unhappy
wife. One crab escaping from the basket
indicates unfaithfulness, and the death of
a crab foretells the death of husband or
wife. These crabs are watched for seven

Fig. 1. Squeezing sugar cane for the Inna Ceremony
in Ailigandi, San Bias. Notice the pre-adolescent
girls with long hair and gold nose rings. They are
wearing the traditional bright-colored applique
"mola" blouses.

days, and predictions are made on the
basis of one year of marriage for each
day. These omens and many others are
more important than just amusing super-
stitions : however, no clear distinction
was evident between genuine divination
techniques and humorous, trivial cus-
toms.

THE INNA CEREMONY

These ceremonies are the most sacred
surviving observances of the Cuna re-
ligion. The details of these rituals, also
attributed to Ipeorkun, have been trans-
mitted by oral tradition through the cen-
turies. These ceremonies consecrate the
female child to her future role in mother-
hood and supply her protection against
disease and other hazards. They are a
form of fertility rite, and symbolically
ensure the survival of the Cuna Indians
as a people. The complex ceremonies
relate through lengthy chants, dances,
and pantomime the sacred mysteries of
creation and the origins of the race. The
senior kantule (high priest) manages
the entire ceremony ; he sings the almost
interminable sacred chants, assisted by
associate kantules and other officials.
Every Indian girl must have an Inna
feast to be eligible for marriage.

Vol. 49, No. 2

McFADDEN— PUBERTY AND GYNECOLOGY IN THE CUNA INDIANS

The Lomj I una: The Long Inna
( Inna Suit) is an clal)orate ceremony
lasting four days. The girl may he any
age hetween three and nine, hut the
average age is seven years. Men take the
major role in these proceedings, which
are held in a large inna hall reserved for
these feasts. The opening phase is the
ritual Inna tasting hy four village elders
and the tohacco smoke incense offered
to each man in turn. After several hours,
the high priest hegins the sacred chants
which will continue almost continually
night and day for three days. The pro-
gram is broken at intervals by ritual
dances, pantomime, and music by "pan
pipes," flutes, and rattles. As he sings
for hour after hour, the men and women
drink Inna and smoke native tobacco to
a state of intoxication.

The girl stays in her hammock sur-
rounded by a palm leaf screen, in a cor-
ner of the hall, until the morning of the
fourth day. She then goes to a previous-
ly prepared palm leaf shelter in the street
near the inna hall. There she sits in a
pit surrounded by matrons and friends
and receives a ritual hair cut from an
older woman, "one who knows the way
of cutting the maiden's hair." The result
is a very close crew cut. She is finally
given a secret and holy name by the high
priest, and then she returns to her family
house. The Inna feast continues usually
for another 12 hours.

The Inna Chants: The sacred Inna
chants describe in flowery language the
development of the girl from her con-
ception to her future role as a mother.
The entire process of reproduction is
related in detail, but the obscure symbolic
vocabulary conceals the meaning from
the general public. The high priest chants
against the many evil influences which
threatened the girl in the past and lurk
to harm her and her pregnancies in the

future. Indian informants say that the
Inna tells the whole story of the girl's
life. This is true ; however, since the
story l)egins with the origin of man fol-
lowing the Great Flood, the Inna ritual
actually recounts the historv of mankind.

The Inna Drink: Inna, the alcoholic
drink which gives its name to the cer-
emonv, and tobacco are the two essential
ingredients of the Inna feast. Inna is
made from ground parched corn, ripe
bananas, and sugar-cane juice fermented
and then boiled. The result resembles a
dark ale or stout in taste and appearance.
An important secondary official is "one
who knows the way of making Inna" or
the master brewer. Both men and women
drink large amounts of Inna because they
believe it necessary to get drunk at Inna
feasts to ensure going to "heaven" after
death. In the obscure and symbolic lan-
guage of the Cuna chants, one of the
names for a human being is "one who
possesses Inna." This usage indicates
both the sacred nature of the drink and
mankind's unique status in possessing it.

Inna Variations: Economic factors
cause some variations in the number and
variety of Inna feasts in different vil-
lages. The required food and drink is
quite expensive, and a father often works
several years to accumulate the money
and supplies. In villages where these
feasts are a cooperative effort, the Long
Inna is common. Several variations of
the Inna are mentioned for completeness.
Inna Tiinsikalct lasts about a day and
a half, and may be substituted for the
Long Inna. Inna Totozvalct is a rare
variation in which every activity is
danced in a specified ritual pattern. This
ceremony is quite complex and is not
often performed today.

Coiuinc/ Out Party: The one day Inna
feast ( Imia Mutiket) is ordinarily held
for a girl of 13 years. The ceremony is

April, 1964

essentially an abbreviated Long Inna
feast, and is tbe girl's "coming ont"
party. She does not receive a ritnal hair
cutting unless she had not been given an
Inna earlier. Usually her mother cuts
her hair to the short adult style a few
weeks after the second Inna, and the
girl adopts the tribal head scarf. She is
commonK- married at 14 or 15 years of
age.

SEX MORES AND MARRIAGE

Children of both sexes are carefully
shielded from any knowledge of the re-
producti\e process. It is difficult to be-
lieve in the complete ignorance of young
people in sexual matters since the large
open houses shelter several generations,
including many married couples. The vil-
lage is so tightly organized and the
houses are so situated that privacy is
achieved only through custom and Indian
courtesy. The young people have abun-
dant opportiniities to see and hear all
possible human activities.

The modesty of the Cuna is influenced
by tribal custom often reinforced by-
village laws. It is partly the result of true
courtesy ( living habits modified to avoid
giving offense to other members of the
community), partly the guarding of
sacred, therefore dangerous, information
from the jniblic, and partly the influence
of foreign cultures. Apparently, what is
concealed from children is the detailed
ritual knowledge of the medicine men.
This knowledge is held too sacred to be
revealed to children, and much of it is
guarded from the adult laity.

Marriage is arranged by the parents
without the consent or prior knowledge
of the couple concerned. They frequently
occur during the celebrations associated
with puberty. The unsuspecting lad is
seized by a group of his friends and
carried to the bride's house, accompanied

Fig. 2. This waterfront of a San Bias village shows
the characteristic large cane and thatch houses and
the brightly painted log canoes. The chiefs and town
council of this very conservative community debated
before permitting our medical party to land here.

by shouts of "husband-husband" and
other appropriate comments. The young
couple is pushed into a single hammock
and swung several times over a burning
log. Afterwards, each takes a bath, and
the boy leaves the house. This is repeated
for several days ; the couple is forced
to spend the night in the same hammock
without moving or sleeping, carefully
chaperoned bv the girl's parents. When,
after several days, the prospective groom
voluntarily accompanies the girl's father
to the mountains and brings back a log
for the fire, the marriage is considered
completed.

The new husband moves into the girl's
household and becomes a member of her
family. The man and woman are ex-
pected to be faithful during marriage ;
however, a separation is not complicated
and the individuals are then free to re-
marry.

The frequent occurrence of albinism
among these people imposes additional
marriage customs. Albinism is attributed
to the prenatal influence of excess ex-
posure to moonlight and certain med-
icinal plants. However, hereditary fac-
tors are recognized also, and albinos are
forbidden to marry each other. Cuna al-

Vol. 49, No. 2

McFADimN—PUBRKTY AND GYNECOLOGY IN THE CUNA INDIANS

l)inos seldom marry because they are
severely handicapped by poor vision, sen-
sitive skin, and premature skin cancers.

GVNFXOLOGY

Diseases in this category are thought
to result from the activities of various
animal sjjirits on specific parts of the
female body. IMie results are visualized
in a real fashion such as mechanical
blocking, knotting of tubes, and displace-
ment of reproductive organs.

The menarche usually occurs at 1 1 or
12 in the average healthy female. ]\[en-
strual periods average between two and
four (la\s in duration and approximate
a ZS to 35 day cycle. Dysmenorrhea is
recognized, but is rarely severe enough
to be an important problem. A tonic
])repared from the stem and root of a
jungle ])lant (member of the ])iper fam-
ily ) is taken twice a day to relieve symp-
toms. During the puberty rite, the girl's
nose is painted with a red stain to ensure
easy menstruation.

Menorrhagia and metrorrhagia are
distinguished from the bleeding asso-
ciated with abortion; however, all vag-
inal bleeding has a similar cause. The
fiow of blood is considered to be the red
waters of the River of Life : therefore,
anything whitish and sticky helps to dry
up this flood. A common remedy is a
tonic ])rei)ared from various vines with
whitish and viscous sap. xA. prescri])tion
for dvsmenorrhagia and menorrhagia
given by the Xcle of Tigre, considered
the l)est of the present-day nelcs, con-
sisted of the ashes of colored scraps of
cloth. The cloth scraps were burned with
chanting and cacao bean incense, and the
ashes were mixed with a sticky sap and
dried in a ball. The patient was directed
to grate this medicine into water and
drink a cup morning and evening. The
rationale is not known, but it ])robably

relates to the Cuna myth of creation. The
Original Mother had different colored
menstrual flows, and from each color a
dift'erent animal world developed, such as
the snake world and the alligator world.

The following assortment of remedies
is mainly of interest to illustrate other
ccjnditions recognized in Cuna medicine.
Sterility problems are treated with a
tonic of a milky white juice by the hus-
band and wife every day for three
months. A drink of roasted mushrooms
may be taken daily for one month. These
nnishrooms have a peculiar tilted cap
and are useful only when sterility is due
to a tilted uterus or crooked l)irth canal.
The couple is further advised to rest, to
improve their diet, and to keep trying.
Contraception therapy includes : the tiny
yellow fruit of a rare tree found only in
the mountains eaten before intercourse,
tonic of the bark of the same tree, and
roasted withered flowers in water. The
couple is further advised to abstain from
intercourse.

Vines and branches with large knots
or swellings are soaked in water to make
baths and tonics which are useful in pel-
vic tumors. Stria of pregnancy, tender
breasts, and dyspareunia each have a
separate regimen. Disturbances in libido
result from demonic influences on the
inherent personality, and are managed by
another specialist whose field suggests
l)sychiatry.

DISCUSSIOX

Any discussion of the medical aspects
of puberty ceremonies and female dis-
eases in a ]M-imitive culture by an out-
sider must be rather general, and any
conclusions must l)e stated cautiously.
This is particularly true when this
knowledge is limited to a few of the
highest priest-healers who consider much
of it too sacred to reveal.

April. 1964

J ha\(.' altcniptcd a l)ric'f. accurate de-
scription of the i)ul)erty ceremonies as
they are performed in tlie Cuna villages
today and a few comments on their
medical-religious signilkance. These rit-
uals are primarily magical-religious in
nature ; the medical aspect is almost en-
tirely protection against the many de-
mons of disease. The Inna ceremony in-
cludes activities suggestive of Christian
haptism and confirmation, activities for
strengthening tribal identification, and
social activities reminiscent of a deb-
utante "coming-out" party.

It appears quite likely that in earlier
days the Inna ceremony was closely as-
sociated with female puberty and mar-
riageability. Probably the introduction of
metal tools, trade goods, and the concept
of private ownership created strong eco-
nomic pressures, which resulted in the
separation of the Long Inna feast from
puberty. However, this is unimportant
because the girl receives the magical pro-
tection of the ritual, even if she is too
young to comprehend it.

The assortment of treatments for gyne-
cological disorders are of interest because
they indicate some of the conditions
recognized in Cuna medicine. No satis-
factory identification was possible for
the plants mentioned because even the
Indian names were considered too sacred
to reveal.

Acknowledgments

Alcibiades Iglesias, Claudio Iglesias, and
Rev. Peter Miller of the San Bias Missions
generously contributed personal knowledge, in-
formation, their influence in contacting various

Fig. 3. The Cuna high priest, wearing a ceremonial
hat of blue and yellow macaw feathers, chants the
Long Inna ritual in Icanti on the Bayano River,
Panama. Cocoa bean incense burns in front of the
medicine canoe full of Inna drink. The honored girl
is hidden behind a shelter of palm leaves on the left.
This is an artist's reconstruction because photographs
were not permitted during the ceremony.

medicine men and interpreting, and transporta-
tion and lodging during my trips to these
villages. Dr. Teodoro A. Arias of the OB/Gyn
Service, Gorgas Hospital, Canal Zone, assisted
with the gynecological aspects of this paper.
The photographs were supplied by Mr. and
Mrs. Xeville A. Harte of Curundu, Canal Zone.

References

1. Keeler, Clyde E. : Secrets of the Ciiiia
Earth Mother: A Comparative Study of An-
cient Religions, New York Exposition Press,
1960.

2. Nordeskiold, Erland: An Historical and
Ethnological Survey of the Cuna hidians (Ed.
by Henry Wassen). Comparative Ethnological
Studies, Vol. 10. Goteborg, 1938.

3. Keeler, Clyde E. : Land of the Moon-
Children: The Primitive San Bias Culture in
Flux. Athens, University of Georgia Press,
1956.

4. Stout, D. B. : San Bias Cuna Accultura-
tion: An Introduction. Viking Fund Publica-
tions in Anthropology, No. 9, New York, 1947.

Vol. 49. No. 2

'Dem 's

LETTER.

MEDICAL SCHOOL SECTION

Dear Members uj the Alumni and Friends oj the Medical
School:

W herever the practice of medicine is considered or dis-
cussed, there are apt to be statements made al)oiit the Art
of Medicine and the Science of Medicine.

In the minds of some, one of these entities can exist
without the other, although most are agreed that first-rate
pliysicians must excel in both the science and art of
medicine.

Science is usually defined as a branch of study concerned
with observation and classification of facts, especially with
establishment of verifiable general laws, chiefly by induction
and hypotheses.

\\'ithin a given field of science the average event can
l)e predicted but not the specific event. Thus in the field
of medical science the general course of tyjjhoid fever can
be predicted. However, how typhoid fever will behave in
a specific patient cannot be predicted as far as complica-
tions are concerned. This is where the experience of the
physician and his mind's interpretation of the clinical
findings of the patient's mind and body becomes the Art
of Medicine.

It is in this way that the science and art of medicine
must function for the patient's good.

The art of medicine cannot exist without an adeciuate
use of the medical sciences. The medical sciences can only
be of minimal effectiveness in patients" care unless they are
interpreted by the able physician with a background of
experience in medical practice.

The University of Maryland Medical School's educa-
tional jjrograms try to provide an adequate liackgroinid in
the sciences and an awareness of the need to develop the
Art of Medicine.

Sincerely,

William S. Stoxe. M.D.
Dean

.-IpnI. 1^64

BVLLETIX OF THE SCHOOL OF MFDICIXF. CXirFRSlTV OF MARY LAX I)

Appointments and Promotions

Dr. M. WiLso.N Toi.i. has Ijecn a])-
pointed Assistant Professor of Pathology
and head of the Division of Cytopathol-
ogy. Dr. Toll has been a practicing
jxithologist most recently in Ray P^rook,
X. v.. and for a nnniher of years prior
to his pri\ate practice, he worked in
Albany, X. V., where he trained in path-
ology at the Bender Laboratory. He is
an alumnus of McGill University, Mon-
treal, and received training in cytology
at Memorial Hospital for Cancer and
Allied Diseases in XFew York City.

Dr. Joseph Stafford Redding has
been named Associate Professor of
Anesthesiology at the School of Medi-
cine and has been promoted to Anes-
thesiologist-in-Chief at the Baltimore
City Hospitals. Dr. Redding has served
on the stafT of the Baltimore City Hospi-
tals since 1958. An alumnus of the Uni-
versity of X^orth Carolina, he received
his medical degree from the University
of Maryland, serving his internship and
residency in anesthesiology at the Xiorth
Carolina Memorial Hospital, Chapel
Hill.

Dr. Jose Ramirez has been appointed
Assistant Professor of Clinical Medicine
in the School of Medicine.

Dr. Ennis C. Lane has been pro-
moted from an instructor in Biochem-
istry to Assistant Professor of Biochem-
istry.

Personals

Among those of the medical faculty
participating in the postgraduate pro-
grams at the Sinai Hospital were includ-
ed Dr. John G. Wiswell and Dr. John
C. Krantz, Jr. Dr. \\'iswell spoke on the
subject "The Relationshij) P)etween

Tluroid I h)rni()ne and Catecholamines,"
while Dr. Krantz covered the subject
"A Pharmacological Approach to Coro-
nar}- Artery Disease."

Dr. Raymond K. Thompson, Asso-
ciate Professor of Neurological Surgery
in the School of Medicine, has been elect-
ed President of the Xeurosurgical So-
ciety of America. The organization is
one of the live major neurosurgical so-
cieties in Xorth zA.merica.

Dr. Thompson also serves as X'^euro-
surgeon-in-Chief at the St. Joseph's, St.
Agnes' and Maryland General Hospitals
in Baltimore.

Lederle Award to Dr. Crispens

Dr. William S. Stone, Dean of the
School of Medicine, has announced that
Dr. Charles G. Crispens, Jr., an Assist-
ant Professor of Anatomy at the School
of Medicine, has l)een named recipient
of a Lederle Medical Faculty Award for
1964.

In announcing the award. Dean Stone
stated that the Lederle Laboratories Di-
vision of the American Cyanamid Com-
pany provides annually a grant for addi-
tional support for medical school faculty
members during their development as
teachers and research workers.

Dr. Crispens, who teaches a course in
medical genetics, is now in the midst of
a study to determine the relationship be-
tween cancer and a virus-like agent
associated with mouse tumors. Since
1955, Dr. Crispens has published more
than 20 articles, many of them dealing
with his study of neoplastic diseases in
birds and mice. He is also the author of
a reference book on X^orth American
game birds.

Con't on p. iii

Vol. 49, No. 2

Grants

Dr. Raskin has hypothecated that
some skin (Hseases are associated with
anto-ininiune factors, indicating that the
])atient may l)e allergic (at times) to his
own tissues.

Department of Biophysics

The School of Medicine and the
Department of Biophysics has received
a three-year grant of $100,000 to support
a study of muscle proteins. The research
will be under the direction of Dr. Malvin
D. Stern, Associate Professor of Bio-
physics.

Dr. Stern is interested in determining
the actin and myosin to form filaments
and hl)rils in muscle. Dr. Stern plans
to use various physical and chemical
techniques including light scattering to
examine the way actin and myosin mole-
cules arrange themselves under various
conditions. He will w^ork with purified
proteins extracted from frog, lobster,
rabbit and other animal muscle.

Dr. Stern, a former Atomic Energy
Commission postdoctoral fellow in bio-
logical sciences at Harvard University,
has l^een associated with the University
of Maryland since 1963. He holds his
B.S. degree from the City College of
Kew^ York, and an M.A. and Ph.D. from
Princeton Universitv.

Dr. Jo.\n Raskix, Assistant Professor
of Dermatology, has received a grant of
$10,765 from the National Institutes of
Health to continue research she has l)een
conducting on the role of allergy in cer-
tain skin diseases, specifically Molluscum
contagiosum. Preliminary studies have
indicated the ])roduction of certain anti-
viral antibodies specific for the virus in
certain individuals who have sutTered
from the infection.

Dr. Cowley Receives Large Grant
for Hyperbaric Oxygen Research

A PRES-SURizED CHAMBER for rcscarch
in hvperl)aric oxygen techniques has been
installed at the School of Medicine at
the cost of some $65,000, defrayed by the
Dixie Manufacturing Company of Bal-
timore, who installed the apparatus at
cost.

Under the direction of Dr. R. Adams
Cowley, head of the Division of Thoracic
Surgery, the 8 x 22-foot test unit will
be employed as a pilot unit for prelimi-
narv studies on animals and eventually
on human lieings. It will l)e followed by
a quarter-million-dollar unit, designed to
accommodate a full surgical team with
all of the ancillarv equii)ment. The larger
chamber was donated by Hercules Pow-
der Company for research at the School
of Medicine.

Although still an experimental method,
hyperbaric therapy has been used suc-
cessfully in the treatment of carbon
monoxide poisoning and in some in-
stances of surgical shock.

Con't from p. ii

A new arrival at the School of Medi-
cine. Dr. Crispens recently com])leted a
year as a postdoctoral fellow at the Jack-
son Laboratory, Bar Harl)or, Me. He
holds a I^.S. degree from Pennsylvania
State University, an ]\I.S. degree from
Ohio State University, and a Ph.D. from
Washington State University.

April. 1^64

Publications of Slafi' of Tlie School of Medicine 1962-1963

DEPARTMENT OF ANATOMY

Ckispexs, C. G., Ju. : Serum Lactic Dehydro-
genase Levels in Mice During the Develop-
ment of Autochthonous and Chemically In-
duced Tumors. /. Nat. Cancer Inst., 30:361,
1963.

Crispexs, C. G., Jr. : Factors Which Influence
Normal Values for Serum Lactic Dehydro-
genase in Mice. Experientia, 19:97, 1963.

Krahl, V. E. : The Glomus Pulmonale : Its
Location and Microscopic Anatomy in Pul-
monary Structure and Function, Ciba Foun-
dation Symposium. Little, Brown & Co.,
1962, p. 53.

Krahl, V. E. : Relationships of Peripheral
Pulmonary Vessels to the Respiratory Areas
of the Lungs. Med. Thorac, 19:194, 1962.

Krahl, \'. E. : Microstructure of the Lung.
Arch. Environ. Health, 6:37, 1963.

Krahl, V. E. : A Method of Studying the
Living Lung in the Closed Thorax and Some
Preliminary Observations. Angiology, 14:149,
1963.

Krahl, V. E. : Cinemicrography of the Living
Lung. Anat. Rec, 145:371, 1963.

Krahl, V. E. : Anatomy of the Mammalian
Lung, Chap. 6, Sec. 3, Vol. I in Handbook
of Physiology. Williams & Wilkins Co.,
Baltimore, 1963.

Krahl, V. E. : Pulmonary Anatomy in A
Symposium on Anthracosilicosis. W. B.
Saunders Co., Philadelphia. In press.

MosES, A. M., Leveque, T. F., Giambattista,
M., and Lloyd, C. W. : Dissociation Between
the Content of Vasopressin and Neurosecre-
tory Material in the Rat Neurohypophysis.
/. Endocr., 26:273, 1963.

Reyxolds, B. L., Leveque, T. F., and Buxtox,
R. W. : Metabolic Responses in Skeletal
Muscle and Connective Tissues to Open Skin
Wounds in Animals. Amer. Surg., 29:1, 1963.

Reyxolds, B. L., Leveque, T. F., and Buxton,
R. W. : Metabolic Parameters in the Healing
of Open Skin Wounds in Animals. Amer.
Surg., 29:5, 1963.

DEPARTMENT OF ANESTHESIOLOGY

Drinker, A. S. and Helrich, M. : Halothane
Anesthesia in Patients with Spinal Cord

Lesions. Anesthesiology, 24:399 (May-June),
1963.

Gold, M. I., and Helrich, M. : A Study of the
Complications Related to Anesthesia in the
Asthmatic Patient. Anesth. & Analg.. 42:283
(March-April), 1963.

Gold, M. I. : Tranquilizing Drugs : Adverse
Reactions Related to Anesthesia and Sur-
gery. Maryland Med. J., 11:500 (Sept.),
1962.

Helrich, M. and Atwood, J. M. : Sernyl
Anesthesia, A Re-evaluation. The Pharma-
cologist (Fall), 1962, p. 155.

Krantz, J. C, Jr., Cascorbi, H. F., Helrich,
M., Burgisox, R. M., Gold, M. I., and Rudo,
F. : A Note on the Intravenous Use of
Anesthetic Emulsions in Animals and Alan
with Special Reference to Methyoxyflurane.
Anesthesiology, 22:491 (May-June), 1961.

Seebert, C. T. and Helrich, M. : A Study of
Blood Transfusion Practices During Cesa-
rean Section. Ohstet. & Gyjicc. In press.

DEPARTMENT OF BIOCHEMISTRY

Thomas, G. H. and Herbst, E. J. : The Effect
of Polyamines on the Latent Ribonuclease of
E. coli. Fed. Proc. 22:349, 1963.

DEPARTMENT OF BIOPHYSICS

AIuLLiNS, L. J.: Efflux of Chloride Ions Dur-
ing the Action Potential of Xitella. Nature,
196:4858, 1962.

MuLLiNS, L. J. : The Concentration Depend-
ence of Sodium Efflux from Muscle. /. Gen.
Physiol., 46:629, 1963.

DEPARTMENT OF MEDICINE

Bixx, L. N., Randall, R., Harrison, V. R.,
GiBBS, C. J., Jr., and Aulisio, C. G. : The
Serological Reactions in a Case of Rift
Valley Fever. Amer. J. Trap. Med., 12:236,
1963.

BiNN, L. N., Randall, R., Harrison, V. R.,
Gibbs, C. J., Jr., and Aulisio, C. G. : Im-
munization Against Rift Valley Fever : The
Development of Vaccines from Non-primate
Cell Cultures and Chick Embryos. Amer. J.
Hyg., 77:160, 1963.

Vol. 49, No. 2

MEDICAL SCHOOL SECTION

Greisman, S. E. and Michaelis, M. : Effect
of Catecholamines During Traumatic Shock
in the Rat. /. Surg. Res. In press.

Greisman, S. E., Hornick, R. B., Carozza,
F. A., Jr., and Woodward, T. E. : Effect of
Endotoxin Tolerance on Human Typhoid
Fever. Trans. Assoc. Aiiirr. Thysicians,
75:170, 1962.

Greisman, S. E., Carozza, F. A., Jr., and
Hills, J. D. : Mechanisms of Endotoxin
Tolerance. I. Relationship Between Toler-
ance and Reticuloendothelial System Phago-
cytic Activity in the Rahbit. /. Exp. Med.,
117:663, 1963.

Greisman, S. E., Hornick, R. B., Carozza,
F. a., Jr., and Woodward, T. E. : The Role
of Endotoxin During Typhoid Fever. I. Ac-
quisition of Tolerance to Endotoxin. /. Clin.
Invest., 42:1064, 1963.

Morrison, S. : In Mcmoriam — Maurice Feld-
man, Sr. Gostrooiterology, 42:641 (May),
1962.

Morrison, S. : Dignity in the Medical Profes-
sion. Maryland Med. J., 12:175 (May), 1963.

Morrison, S. : Organizations. Open Forum.
Maryland Med. J., 12:203, 1963.

Randall, R., Gibbs, C. J., Jr., Aulisio, C.
G., Binn, L. N., and Harrison, V. R. : The
Development of a Formalin-Killed Rift Val-
ley Fever Virus Vaccine for Use in Man.
/. Inunun.. 89:660, 1962.

Randall, R., Binn, L. N., and Harrison, V.
R. : Rift Valley Fever Vaccine. Amcr. J .
Trap. Med. In press.

Woodward, T. E. : Chemosuppression of Spe-
cific Infections with Antibiotics. /. Chron.
Dis., 15:611, 1962.

Woodward, T. E. : Typhoid Fever : A Discus-
sion of its Pathogenesis, Physiologic Abnor-
malities and Management. Tra)is. College
Physicians. In press.

Woodward, T. E. and Smadel, J. E. : Man-
agement of Typhoid Fever and Its Compli-
cations in Science, 'Technology, and Develop-
ment. Vol. VI. Government Printing Office,
Washington, D. C, 1963, p. 94.

Woodward. T. E. : Tularemia in Cccil-Loeb
Textbook of Medicine. 11th Ed. W. B.
Saunders Co., Philadelphia, 1963.

Woodward, T. E. : Typhoid Fever in Current
Pediatric Therapy. W. B. Saunders Co.,
I'hiladelphia, 1963. In press.

Division of Cardiology

Dembo, D. H. : Cardiac Work Evaluation Unit.

Heart Page. Maryland Med. J. In press.

JuDE, J. R., ScHERLis, L. and Farr, M. E. :
CardiopuUnonary Resuscitation — A Manual
for Instructors. The Heart Association of
Maryland. Revised January, 1963.

Lee, Y. C. and Hicken, W. J.: Anomalous
Origin of the Left Coronary Artery Arising
from the Pulmonary Artery in an Infant :
Report of a Case. Bull. Sch. Med. Univ.
Maryland, 48:12, 1963.

Papadopoulos, C. and Blazek, C. : Ventricular
Tachycardia of 70 Days Duration with Sur-
vival. Amer. J. Cardiol., 11:107, 1963.

Scherlis, L. and Lee, Y. C. : Transient Right
Bundle Branch Block. An Electrocardio-
graphic and Vectorcardiographic Study.
Amer. J. Cardiol., 11:173, 1963.

Scherlis, L., Koenker, R. J., and Lee, Y. C. :
Pulmonary Stenosis : Electrocardiographic,
Vectorcardiographic, and Catheterization
Data. Circulation. In press.

Scherlis, L. and Lee, Y. C. : Recurrent Hy-
pertension in a Patient with Chronic Aor-
toiliac Thrombosis and Renal Artery Ob-
struction Successfully Treated on Two Occa-
sions by Partial Nephrectomy. Ann. Intern.
Med. In press.

Division of Clinical Pathology

Jiji, R. M., Gangerosa, E. J., and de la
Macorra, F. : Chloramphenical and Its Sul-
famoyl Analogue : Report of Reversible Ery-
thropoietic Toxicity in Healthy Volunteers.
Arch. Intern. Med.. 111:70. 1963.

Division of Dermatology

Raskin, J.: Molluscum Contagiosum : Tissue
Culture and Serologic Study. Arch. Derm.,
87:552, 1963.

Robinson, H. M., Jr. and Dunseath, W. J.
R. : Micronized Griseofulvin, /. Inz'cst.
Derm.. 39:65. 1962.

Robinson, H. M., Jr., Robinson, R. C. V.,
and Hollander, M. B. : Sebaceous Secretion
and Comedones ( Quantitive Study). Bull.
Sch. Med. Univ. Maryland. 47:31, 1962.

Robinson, H. M., Jr.: Patient Presentation
Textbook of the Twelfth International Con-
gress of Dermatology. Horn-Schafer Co.,
Baltimore, 1962.

RoBixsox, R. C. v.: Treatment of Erysipelas,
Current Therapy — 1962. W. B. Saunders
Co., Philadelphia, 1962.

Robinson, R. C. V. and Roberts, D. : Occi-
pital Nevus Fammeus. Southern Med. J.,
55:1292, 1962.

April, 1064

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Division of Endocrinology and Metabolism

Ci.AKK, R. L., Ci.wis, F. M., and Bradford,
W. L. : A Study of the Possible Relationship
of Progesterone to Colic. Pediatrics, 31:65,
1963.

Connor, T. B. and Lovice, H. : Observations on
Renal Function Before and After Correction
of Hypercalcemia. Trans. Amcr. Clin. &
Climat. Assoc, 1962. In press.

Ganis, F. M. : A Practical Support for Ascend-
ing and Descending Paper Chromatography.
/. Chromatog.. 7:570, 1962.

Howard, J. E. and Connor, T. B. : The Use of
Differential Renal Function Studies in the
Diagnosis of Renovascular Hypertension.
Amcr. J . Sure;. In press.

General Medical Clinic

Blum, L. V. and Atagun, M. : Diabetes Mel-
litus at the Tuberculosis Division of Balti-
more City Hospitals. Maryland Med. J., Jan.,
1963.

Esmond, W. G., Attar, S., Cowley, R. A.,
and Blair, E. : Anatomy of Peripheral Ram-
ification of the Cardiac Conduction System.
Circulation, 1962, p. 732.

Esmond, W. G., Attar, S., Merlis, J. K.,
Scott, W. H., Richards, R. D., and Cow-
ley, R. A. : Metabolic, Hematologic, and
Neuropsychological Studies on Patients Un-
dergoing Open Heart Surgery with Pro-
found Hypothermia. Proc. 22nd Intcrnat.
Cong, on Physiol. Sci., 1962.

Esmond, W. G., Attar, S., and Cowley, R.
A.: Hyperbaric Oxygenation in Medical and
Surgical Conditions : Application in Experi-
mental Vascular Collapse. Proc. 2nd San
Diego Symp. for Bioincd. Eng., 1962, p. 311.

Esmond, W. G., Attar, S., and Cowley, R.
A. : Hyperbaric Oxygenation in Experimen-
tal Hemorrhagic Shock : Experimental
Chamber Design and Operation. Trans.
Amcr. Soc. for Artificial Internal Organs,
Vol. VIII, 1962, p. 384.

Esmond, W. G., Attar, S., Borges, F., Cow-
ley, R. A., HoLLiNGSwoRTH, N., and Blair,
E. : Use of Mannitol in Postperfusion Oli-
guria-Anuria. Circulation, 1963, p. 699.

Esmond, W. G., Cowley, R. A., Attar, S.,
Blair, E., and Hawthorne, I. : Electro-
cardiographic and Biochemical Studies in
Hemorrhagic Shock Treated with Hyper-
baric Oxygenation. Circulation, 1962, p. 670.

Esmond, W. G., Attar, S., and Cowley, R.
A. : Hyperbaric Oxygenation in Vascular

Collapse. /. llior. & Cardiov. Surg., 44:759,
1962.

Esmond, W. G., Moulton, G. A., and Michae-
Lis, M. : Effects of Hyperbaric Oxygenation
on Noble Collip Drum Shock in the Rat.
Bull. Sell. Med. Univ. Maryland. 47:42, 1962.

Freeman, I. : Anticoagulants and Atrial Fi-
brillation. J. A.M. A. In press.

ScHUBART, A. F., Rothschild, H. J., Schroed-
er, W. C, and Ewald, R. W. : Changes of
Serum Complement Levels in Acute Rheu-
matic Fever. A Longitudinal Study. Arthritis
& Rheum., 5:656. 1962.

Division of Hypertensive & Renal Diseases

Attar, S., Borges, F. J., Cowley, R. A., Es-
mond, W. E., HoLLiNGSWORTH, N., and
Blair, E. : Use of Intravenous Mannitol in
Postperfusion Oliguria and Anuria. Circula-
tion, 1963, p. 699.

Borges, F. J. : Work Prescription and the
Cardiac Patient. Report of Heart Associa-
tion of Maryland, 1963, p. 43.

Madeloff, M. S., Schwartz, F. D., Borges,
F. J., Revell, S. T. R., Jr., and Young, J.
D., Jr. : Differential Excretion of Sodium
and Water in Man Following Infusion of
Inulin and Para-Aminohippurate. Arch.
Surg., 1962, p. 944.

Division of Infectious Diseases

Greisman, S. E., Hornick, R. B., Carozza, F.
A., Jr., and Woodward, T. E. : The Role of
Endotoxin During Typhoid Fever and Tu-
laremia in Man. /. Clin. I invest., 42:1064,
1963.

McCrumb, F. R., Jr. : Plague in the Cecil-Loch
Textbook of Medicine. 11th Ed. W. B.
Saunders Co., Philadelphia. 1963.

Wagner, H. N., Jr., Iio, M., and Hornick,
R. B. : Studies of the Reticuloendothelial
(RES) II. Changes in the Phagocytic Ca-
pacity of the RES in Patients with Certain
Infections. /. Clin, hn'cst., 42:427, 1963.

Division of Neurology

Cai'RILES, L. F. : Intracranial Hypertension
and Iron Deficiency Anemia. Arch. Neurol.
In press.

Heck, A. F. : William Alexander Hammond.
J.A.M.A.. 183:170, 1963.

Heck, A. F. : Heart Disease in Friedreich's
Ataxia. Part I. Clinical Studies and Review
of the Literature. Neurology, 13:587, 1963.

Heck, A. F. : Heart Disease in Friedreich's

Vol. 49. No. 2

MEDICAL SCHOOL SECTION

Ataxia. Part II. Investigation of Cardiac-
Disease in a Large Family with Friedreich's
Ataxia. Neurology, 13:596, 1963.

Heck, .A. F. : Presumptive Sex-linked Inter-
mediate Transmission of Retinal Degenera-
tions. .Irch. OphthaJ. In press.

Ide.^, B. V. : Clinical Appraisal of Pentapi-
peride Methyl Sulfate — A New Anti-cho-
linergic Drug. Aiiicr. J. (rasfrocnt., Jan.,
1963, p. 52.

Kramer, AI. D. : Biheriden in the Treatment
of Phenothiazine-induced Extrapyramidal
Reaction. J. A.M. A.. 182:1127, 1962.

Merli.^, J. K. : Epilep.sy in Progress in Neu-
rology and Psycliiatry, 1962, p. 172.

Merlis, J. K. : Ahnormal Excitatory Activity :
Epilepsy in Neural Physiopathology. Harper
& Rowe, New York, 1962, p. 69.

Teitelb.^um. H. a. : Psychomatic Aspects of
Nervous System Disease. Psyclwsoiiiafics,
Nov.-Dec, 1962.

Van Buskirk, C. : Current Trends in Treat-
ment of Cerebrovascular Disease. Maryland
Med. J . In press.

DEPARTMENT OF NEUROPHYSIOLOGY

AIerlip, J. K. : Epilepsy in Progress in Neu-
rology and Psyehiatry, 1962, p. 172.

Merli.s, J. K. : Abnormal Excitatory Activity:
Epilepsy in N^eural Physiopathology. Harper
& Rowe, New York, 1962, p. 69.

DEPARTMENT OF MICROBIOLOGY

El Batawi. Y., Wisseman, C. L., Jr., Wood,
W. H., Jr., and Noriega, A. R. : Allergic
and Toxic Skin Reactions in Man to Typhus
Rickettsiae. Fed. Proc., 22:616, 1963.

Eylar, O. R., and Wisseman, C. L., Jr. : En-
hancement of West Nile Virus Neutraliza-
tion by Fresh Normal Serum. Baet. Proc.,
1963, p. 155.

Provost, P. }., Myers, W. F., and Wisse-
man, C. L., Jr. : A Differentially Permeable
Cytoplasmic Membrane in Rickettsia moo-
seri. Baet. Proc. 1963. p. 133.

RosENZWEiG. E. C, Babione, R. W., and
Wisseman, C. L., Jr.: Immunological
Studies with Group B .Arthropod -borne
Viruses. IV. Persistence of Yellow Fever
.Antibodies Following Vaccination with 17D
Strain Yellow Fever Vaccine. Amer. J . Trop.
Med., 12:230, 1963.

Smith, A. G., Taubert, H. D., and Towns,
C. AL : Comparative Media Studies in the

Isolation of Candida al ''icons from Pregnant
Women. Mycopatholagia et Mycologia Ap-
plicata, 17:269, 1962.

Smith, A. G., Taubert, H. D., and Martin,
C. W. : The Use of Trichomycin in the
Treatment of Vulvovaginal Mycosis in
Pregnant Women. Anier. J. Obstet. &
Gynec. In press.

Sweet, B. H., Wisseman, C. L., Jr., Kitaoka,
M., and Tamiya, T. : Immunological Studies
w^ith Group B Arthropod-borne Viruses. II.
Effect of Prior Infection with Japanese En-
cephalitis Virus on the Viremia in Human
Subjects Following Administration of 17D
Yellow Fever Vaccine. Amer. J . Trop. Med.,
11:562, 1962.

Verna, J. E. and Eylar, O. R. : Rabbit Fi-
broma Virus Plaque Assay and in vitro
Studies. Virology, 18:266, 1962.

Wisseman, C. L., Jr., Sweet, B. H., Kitaoka,
M., and Tamiya, T. : Immunological Studies
with Group B Arthropod-borne Viruses. I.
Broadened Neutralizing Antibody Spectrum
Induced by Strain 17D Yellow Fever Vac-
cine in Human Subjects Previously Infected
with Japanese Encephalitis Virus. Amer. J.
Trop. Med., 11:550, 1962.

Wisseman, C. L., Jr. and Sweet, B. H. : Im-
munological Studies with Group B Arthro-
pod-borne Viruses. III. Response of Human
Subjects to Revaccination with 17D Strain
Yellow Fever Vaccine. Amer. J. Trop. Med..
11:570, 1962.

Wisseman, C. L., Jr., Gauld, J. R., and Wood,
J. G. : Interaction of Rickettsiae and Pha-
gocytic Host Cells. HI. Opsonizing Anti-
bodies in Human Subjects Infected with
Virulent or Attenuated Rickettsia prozca-
cekii or Inoculated with Killed Epidemic
Typhus Vaccine. /. Immun.. 90:127, 1963.

Wisseman, C. L., Jr.: Global Medicine: A
New Dimension. Bull. Sch. Med. Unir.
Maryland, 48:1, 1963.

Wisseman, C. L., Jr. : Armed Forces Epide-
miological Board. Activities of the Commis-
sion on Rickettsial Diseases. Milit. Med.,
128:444, 1963.

Wisseman, C. L., Jr., Sweet, B. H.. Rosen-
zwEif., E. C, and Eylar, O. R. : Attenuated
Living Type 1 Dengue Vaccine ( In Sym-
posium on Arborvirus \'^accines ) . .Imer. J.
Trop. Med. In press.

Wisseman, C. L., Jr., Gajdusek, D. C,
ScHOFiELD, F. D., and Rosenzweig, E. C. :
-Arthropod-borne Virus Infections of Abo-

April, 1964

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

rigines Indigenous to Australasia : A Partial
Preliminary Report of a Collaborative Study.
Med. J. Papua & Neiv Guinea. In press.
WissEMAN, C. L., Jr., Wood, W. H., Jr.,
XoRiEGA, A. R., Jordan, AI. E., Rill, D.
J. : Antibodies and Clinical Relapse of Mu-
rine Typhus Fever Following Early Chemo-
therapy. Ann. Intern. Med., 57:743, 1962.

DEPARTMENT OF OBSTETRICS
& GYNECOLOGY

MuNFORD, R. S. : Invasive Carcinoma of the
Cervix Associated with Pregnancy. Mary-
land Med. J., May, 1962.

Smith, A. G., Taubert, H. D., and Towns,
C. M. : Comparative Media Studies in the
Isolation of Candida albicans from Pregnant
Women. Mycopathologia et MycoJogia Ap-
plicata. Vol. XVII, 1962.

DEPARTMENT OF OPHTHALMOLOGY

Fox, S. L. : Pseudomonas-Contaminated Fluo-
rescein Stock Solution. Clin. Med., Sept.,
1962.

Fox, S. L. : An Instrument for Removing For-
eign Bodies from the Cornea. Amer. J.
Ophthal, March, 1963.

Goldberg, J. R. : Gamma Radiation in the
Treatment of Squamous Cell Carcinoma of
the Limbus. Amer. J. Ophthal., April, 1963.

Richards, R. D. : Lipids in Diabetic Retino-
pathy. J. Amer. Geriat. Soc., 10:831, 1962.

Van Bijsterveld, O. P. and Richards, R. D. :
Pituitary Tumors and Intraocular Pressure.
Amer. J. Ophthal. In press.

DEPARTMENT OF PEDIATRICS

Bessman, S. p., Hammel, C. L. : Protein
Synthesis in Nuclei of Avian Erythrocytes.
Biochcm. & Biophys. Res. Comm., 7:26,
1962.

Bessman, S. P. and Baldwin, R. : Imidazole
Aminoaciduria in Cerebromacular Degen-
eration. Science, 135:789, 1962.

Bessman, S. P. and Fishbein, W. N. : Gamma
Hydroxybutyrate — A New Metabolite in
Brain. Fed. Proc., 22:334, 1963.

Bradley, J. E. : Blood Pressure Determina-
tions in Infants and Children. C^ir. M. Digest,
30:53, 1963.

Carter, J. A. : Frequency Distribution Analysis
of Heart Sounds. Bull. Sch. Med. Univ.
Maryland, 47:56, 1962.
Clemmens, R. L., Jantz, E. M. and Schiff-
MAN, G. : Reading Disability as a Familial
Characteristic. Southern Med. J., 55:1329,
1962.
Clemmens, R. L. : Inter-Disciplinary Diag-
nostic Clinics and the Mentally Retarded
Child. Maryland Med. Bull. In press.
Clemmens, R. L. and Schiffman, G. B. :
Hereditary Factors in Certain Reading Dis-
abilities. Proc. College Rcadi)ig Assoc, 1963.
Eichler, M. and Bessman, S. P. : A Double-
Blind Study of the Efifect of Ammonium In-
fusion on Psychological Functioning in Cir-
rhotic Patients. /. Nerv. & Ment. Dis.,
134:539, 1962.
Gorten, M. K. and Hefner, R. : Hyperbili-
rubinemia and Weight Loss in Premature
Infants. Amer. J. Dis. Child.. 104:577, 1962.
Gorten, M. K., Hefner, R.. and Workman,
J. B. : Iron Metabolism in Premature Infants.
I. Absorption and L^tilization of Iron as
Measured by Isotope Studies. Pediatrics. In
press.
Hefner, R. : Revision of Unit 4 on "The New-
born" in DeLee's Obstetrics for Nurses. W.
B. Saunders Co., Philadelphia, 1962.
Hefner, R. : Care of the Premature. Current
Therapy. W. B. Saunders Co., Philadelphia,
1963.
Hefner, R. : A Metabolic Bed for Infants in

Incubators. Fed. Digest, June, 1963.
Klaus, M., Tooley, W. H., Weaver, K. H.,
and Clements, J. A. : Lung Volumes in
Newborn Infants. Pediatrics. 30:111, 1962.
Kress, M. B. and Finkelstein, A. H. : Giant
Bullous Emphysema Occurring in Tubercu-
losis in Childhood. Pediatrics, 30:269, 1962.
Shaw, C. E., Jr., Hurwitz, G. E., Schmuk-
LER, M., Bracer, S. H., and Bessman, S.
P. : A Clinical and Laboratory Study of In-
sulin Dosage in Diabetic Acidosis : Com-
parison with Small and Large Doses. Dia-
betes, 2:23, 1962.
Walker, S. H. : Periodic Fever in Juvenile

Regional Enteritis. /. Pediat., April, 1962.
Walker, S. H. : Encephalitis Due to Group
B, Type 5 Coxsackie Virus. Amer. J. Dis.
Child., Feb., 1963.
Walker, S. H. : The Respiratory Manifesta-
tions of Systemic Hemophilus Influenza In-
fection. /. Pediat., March, 1963.

Vol. 49. No. 2

MEDICAL SCHOOL SECTION

DEPARTMENT OF PATHOLOGY

FiRMiXGER, H. I.: Letter Concerning Training
in Experimental Pathology in "Education
and Research in Pathology." Bull. Coll.
Amcr. Path., 16:77, 1962.
FiRMiNGER, H. I. : Letter to the Editor "Med-
ical Progress in Africa — Cirrhosis and
Hepatic Carcinoma." Aiiicr. J. Clin. Path..
38:639, 1962.
HicKEX, W. J. and Lee, \. C. : Anomalous
Left Coronary Artery Arising from Pul-
monary Artery in an Infant. Bull. Sell. Med.
Cuk: Maryland. 48:12, 1963.
HicKEX, W. J. and Scherlis, S. : Angioma-
tosis of the Pericardium — A Report of a Case
and Review of the Literature. Aim. Intern.
Med. In press.
MouLTOX, G. A. : Central Nervous System
Lesions — Fatal or Xot? Con.uilfant, July,
1962.
MouLTOx, G. A., EsMoxD, W. G., and
MicHAELis, M.: Effect of Hyperbarbaric
Oxygenation on Noble Collip Drum Shock
in the Rat. Bull. Seh. Med. Univ. Maryland,
47:42, 1962.
Naib, Z. AI. and Goldsteix, H. G. : Exfoliative
Cytology of a Case of Bronchial Granular
Cell Myoblastoma. Dis. Chest, 42:645, 1962.
Naib, Z. M. : Cytologic Diagnosis of Cyto-
megalic Inclusion Body Disease. Ainer. J.
Dis. Child., 105:153, 1963.
Naib, Z. M., Powder, J. R., and Youxg, J. D.,
Jr. : Cytolog\' Diagnosis of an Early Gross
Invisible Transitional Cell Carcinoma of the
Renal Pelvis. /. Urol., 89:566, 1963.
Naib, Z. AI. : Exfoliative Cytology of a Case
of Bronchial Granular Cell Myoblastoma.
Dis. Chest, Dec, 1962.
Naib, Z. M. : Exfoliative Cytology in I^^ungus
Diseases of the Lung, .ieta Cytoloi/iea. Sept.-
Oct., 1962.
Naib, Z. M. : Cytologic Diagnosis of Cyto-
megalic Inclusion Body, .inter. J . Dis. Child.,
105:153. 1963.
Reuber, M. D. and Fik.mixger, H. L. : Effect
of Progesterone and Diethylstilbestrol on
Hepatic Carcinogenesis and Cirrhosis in
A X C Rats Fed N-2-fIuorenyldiacetamide.
/. A'<7/. Caneer lust.. 29:933, 1962.
Reuber, M. D. and Schmieler, G. C. : P2detate
Kidney Lesions in Rats. Arch. Environ.
Health. 5:430, 1962.
Reuber, M. D. : Paratliyroid Hy])er])iasia,
Multicvstic Kidnevs, Osteitis Fibrosa Gen-

eralisata and Metastatic Calcification in Cir-
rhotic Rats Fed N-2-fIuorenyldiacetamide.
Amer. J. Path., 41:645, 1962.

Storey, P. B. and Goldsteix, W. : Pulmonary
Embolization from Primary Hepatic Carci-
noma. Arch. Intern. Med., 110:262, 1962.

Wagxer, J. A. and Wistozkey, H. : Cerebral
Cortical Biopsy : A New Vista for the
Pathologist. Southern Med. J., 56:415, 1963.

Wood, C. and Borges, F. J. : Perimuscular
Fibrosis of Renal Arteries with Hyperten-
sion. Arch. Intern. Med., 112:79, 1963.

DEPARTMENT OF PHARMACOLOGY

Bell, F. K., O'Neill, J. J., and Burgisox, R.
M. : Determination of the Oil/Water Dis-
tribution Coefficients of Glyceryl Trinitrate
and Two Similar Nitrate Esters. /. Pharmac.
Sci., 52:637, 1963.
Burgisox, R. M. : "Animal Screening Tech-
niques for the Evaluation of Anesthetic
Agents," a chapter in Pharmacologic Tech-
niques, Yearbook Publishing Co., 1963.
Burgisox, R. M., Lu, G. G., Cowley, R. A.,
and Krantz, J. C, Jr.: Studies on a New
Coronary Vasodilator, l-Chloro-2, 3-Pro-
panediol Dinitrate. Angiology, 13:412, 1962.
Burgisox, R. M., Lu, G. G., Bell, F. K., and
Kraxtz, J. C, Jr.: Nitrites XX. Pharma-
cologic Studies with 1-Ethylglyceryl Trini-
trate. Proc. Soe. E.vper. Biol. Med.. 111:245,
1962.
Cascorbi, H. F., Rudo, F. (}., and Lu, G. G. :
Acute Toxicity of Intravenous Sodium
Lauryl Sulfate. /. Pharmac. Sci.. 52:803.
1963.
Kraxtz, J. C, Jr.: Volatile Anesthetics and

Indoklon. /. N europsychiat., 4:157, 1963.
Krantz, J. C, Jr. : Mannitol Therapy — Cur-
rent Status. Cur. Med. Digest. 30:41, 1963.
Lixg, a. S. C. and Krantz, J. C, Jr.: The
Effect of his (2, 2, 2-trifluoroethyl ) Ether on
Brain Electrolytes and Water Distribution
in the Rat. Biochcm. Pharma., 12:394, 1963.
O'Neill, J. J., Simox, S. H., and Cu.mmixs,
J. T. : Inhibition of Stimulated Cerebral
Cortex Respiration and Glycolysis by Cho-
linolytic Drugs. Biocheui. Pharmac. 12:809,
1963.
RozMAX, R. S., Sacks, R. P., and Kates, R. :
Rapid Measurement of Hemoglobin As by
Means of Cellulose Acetate Membrane Elec-
trophoresis. /. Lab. Clin. Med.. 62:692, 1963.
Truitt, E. B., Jr., Duritz, G., and Ebers-
BERGER, E. AL : Evidence of Monoamine O.xi-

April, 1964

BULLETIX OF THE SCHOOL OF MEDICINE, UXirERSlTY OF MARVLAXD

dase Inhibition by Alyristicin and Nutmeg.
Proc. Soc. Expcr. Biol. Med., 112:647, 1963.
Truitt, E. B., Jr. : Some New Aspects of an
Old Drug: Aspirin. Bull. Sch. Med. Univ.
Mary laud, 48:6, 1963.

DEPARTMENT OF PHYSICAL THERAPY

L.\TiMER. R. ]M. : Paralysis in Morocco due to
Triorthocresyl Phosphate : A Report on the
Neuromuscular Condition of 460 Patients.
/. Aincr. Physical Thcr. Assoc, June, 1962.

DEPARTMENT OF PHYSIOLOGY

Adelm.^n, W. J., Jr.: A Sucrose Gap-Axial
Wire Voltage Clamp. Fed. Proc, 22:174,
1963.

Adelman, W. J., Jr. and Gilbert, D. L. : Volt-
age Clamp Studies on Internally Perfused
Squid Axons. Biophys. Soc Ahsir., Feb.,
1963.

Barraclough, C. a. and Gorski, R. A.:
Studies on Mating Behavior in the Andro-
gen-Sterilized Female Rat in Relation to
the Hypothalamic Regulation of Sexual Be-
havior. /. Endocrin., 25:175, 1962.

Barraclough, C. A. and Cross, B. A. : Unit
Activity in the Hypothalamus of the Cyclic
Female Rat: Effect of Genital Stimuli and
Progesterone. /. Endocrin., 26:339, 1963.

Barraclough, C. A. : Hypothalamic Regula-
tion of LH and FSH Secretion in the Andro-
gen-Sterilized Persistent-Estrous Rat. Ad-
vances in Ncnrocndocrinology. University of
Illinois, Urbana, 1963.

Coleman, P. D. : Failure to Localize the
Source Distance of an Unfamiliar Sound.
J. Acoust. Soc Amcr.. 34:345, 1962.

CoLEMAX, P. D. : An Analysis of Cues to
Auditory Depth Perception in Free Space.
Psychol. Bull.. 60:302, 1963.

Glaser, E. M. : A Data Processing System
for Microelectrode Recordings. IRE, Trans.
Biomcd. Electron, 9:190, 1962.

Heriot, J. T. and Coleman, P. D. : The Effect
of Electro-Convulsive Shock on Retention
of a Modified "One Trial" Conditioned
Avoidance. /. Comp. Physiol. Psychol.,
55:1082, 1962.

Pinter, G. G. and O'Morchoe, C. C. C. :
Effect of Acetylcholine on Renal Function.
Fed. Proc, 22:218, 1963.

VAX der Loos, H. and Glaser, E. M. : Semi-
Automatic Quantitation of Dendrite Char-

acteristics in Cerebral Cortex. Atiat. Rcc,
145:295, 1963.

DEPARTMENT OF PREVENTIVE
MEDICINE AND REHABILITATION

Extwisle, G. : Evaluation of Research Pro-
grams in Home Care Services. Ann. Nezc
York Acad. Sci.. May, 1963.

Fleischer, C. J. : The Role of the Nursing
Home in Rehabilitation of Geriatric Patients.
Geriatric Institutions, 6:11, 1963.

Henderson, M., Entwisle, G., and Tayback,
M. : Bacteriuria and Pregnancy Outcome :
Preliminary Findings. Anicr. J. Public
Health, 52:1887, 1962.

Lawther, p. J., CoMMiNS, B. T., and Hen-
derson, M. : Carbon Monoxide in Town Air :
An Interim Report. Ann. Occup. Hyg.,
5:241, 1962.

Tayback, M., and Frazier, T. M. : Continu-
ous Health Surveys a Necessity for Health
Administration. Public Health Reports, Vol.
77, Sept., 1962.

Tayback, M. and Wallace, H. : Maternal
and Child Health Services and Urban Eco-
nomics. Public Health Reports, Vol. 77, Oct.,
1962.

DEPARTMENT OF PSYCHIATRY

Anderson, A. R. and McLaughlin, F. : Some
Observations on Psychoanalytic Supervi-
sion. Psychoanalytic Quarterly, 32:77, 1963.

Aaroxson, H. and Gilbert, A. : Preadolescent
Sons of Male Alcoholics : An Experimental
Study of Personality Patterning. Arch. Oen.
Psychiat., 8:235, 1963.

Brody, E. B. : Continuing Problems in the Re-
lationship Between Training in Psychiatry
and in Psychoanalysis in the U.S.A. /. Nerv.
& Ment. Dis.. 136:58, 1963.

Bkouy, E. B. : Color and Identity Conflict in
Young Boys. Observations of Negro Mothers
and Sons in L^rban Baltimore. Psychiatry.
26:188. 1963.

Bkody, E. B. : From Schizophrenic to Homo-
sexual. A Crisis in Role and Relating. Anier.
J. Psychother. In press.

Derbyshire, R. L.. Brody, E. B., and Schleif-
ER, C. : Family Structure of Adult Alale
Xegro Mental Patients : Some Preliminary
Observations from Urban Baltimore. /.
Nerv. & Ment. Dis.. 136:3, 1963.

Vol. 49, No. 2

MEDICAL SCHOOL SECTION

Derbyshire, R. L. and Brodv, E. B. : Identity
and Ethocentrisni in American Negro Col-
lege Students. Mental Hygiene. In press.

Derbyshire, E. L. and Bkody, E. B. : Mar-
ginality. Identity, and Behavior in the Amer-
ican Negro; a Functional Analysis. Infernaf.
J. Psycliidt. In ])ress.

EicHLEK, M. and Lansdowne, M. : Detection
of Mood Elevation in a Double Blind Study
of a Monamine Oxidase Inhibitor, Pargyline
Hydrochloride, in a Geriatric Population.
March. 1963.

Grenei.l, R. G. : Neural Pliysiopathohu/y.
Harper & Row, New York, 1962.

Grenei.l, R. ('•.: Molecular Biology and Psy-
chopathology. An)i. Nezc York Aead. Sei.,
96:345, 1962.

Grenell, R. G. and Davies, P. W. : Metabo-
lism and Function in the Cerebral Cortex
Under Local Perfusion, With the Aid of an
Oxygen Cathode for Surface Measurement
of Cortical O.xygen Consumption. /. Neuro-
physiol., 25:651, 1962.

Howe, E. S. : Probabilistic Adverbial Qualifi-
cations of Adjectives. /. Wvbal Learning &
Verbal Behavior, 1:225, 1963.

HuFFER, V. : Fee Problems in Supervised
Analysis. Ihtll. Pliila. Assoc. Psyclioanal.
In press.

Klee, G. D. : Lysergic Acid Diethylamide
(LSD-25) and Ego Functions. Arch. Gen.
Psychiat.. 8:461, 1963.

KuBiE, L. S. : The Fallacious Misuse of the
Concept of Sublimation. Psychoanal. Quart.,
31:73, 1962.

KuBiE, L. S. : The Fostering of Creative Scien-
tific Productivity. Daedalus, 91:294, 1962.

KuBiE, L. S. : The Concept of Dream Depriva-
tion : .\ Clinical Analysis. Psychnsoin. Med.,
24:62, 1962.

KuBiE, L. S.: King-.Vnderson Bill. J. A.M. A..
181:653, 1962.

KuBiE, L. S. : The Maturation of Psychiatrists
or the Time that Changes Take. /. Nerv. &■
Mcnt. Dis., 135:286. 1962.

KuBiE, L. S. : Guilt by Loose .Analogy. /. Nerv.
& Ment. Dis., 133:281, 1962.

KuBiE, L. S. : The Modern Massacre of the
Innocents. /. Nerz: & Ment. Dis.. 135:1.
1963.

KuBiE, L. S. : Neurosis and Normality in The
Encyclopedia of Mental Health. 1963.

MiDDLETOX. E. and Huffer, V.: Obstetricians
and Their Patients. Psychosoinatics. In
press.

Monroe, R. R. : Tlie Daeseianalytic Use of
Dreams. Anier. J. Psychoanal., 23: 1963. In
press.

Monroe, R. R., Heath, R. G., and Leif, H. :
The Integration of Psychiatric and Psycho-
analytic Training at Tulane : The Psycho-
analyst as Teacher and .Administrator. Sci-
ence and Psychoanalysis, Vol. 5, 1962.

Monroe, R. R., Balis, G. U., and Ebersberg-
ER, R. : Anticonvulsant Activity of Alpha and
Beta Chloralose in Rats. Ciir. Therap. Resi-
dents, Vol. 5, March, 1963.

Monroe, R. R., Balis, G. U., and Ebersberg-
ER. R. : The Hypotic Effects of Alpha and
Beta Ch'.oralose in Rats. Cur. Therap. Resi-
dents. Vol. 5, March, 1963.

Overall, B. and Aaronson, H. : Expectations
of Psychotherapy in Patients of Lower So-
cioeconomic Class. Ainer. J. Ortho.. 33:421,
1963.

Pope, B. and Siegman, A. W. : The Effect of
Therapist Verbal Activity Level and Spe-
cificity on Patient Productivity and Speech
Disturbance in the Initial Interview. /. Con-
sult. Psychol.. 26:489, 1962.

Reid. J. R. : Truth, Values, and Psychoanalysis.
Science & Psychoanal., Vol. 5, 1962.

Reid, J. R. : The Myth of Doctor Szasz. /.
Nerv. (S- Ment. Dis.. 135:38, 1962.

Robinson, H. A. and Silverstein, A. B. : Ef-
fects of Medical Education on Interests and
Attitudes. Maryland Med. L. 1963. In press.

Robinson, H. A. : Editorial Introduction. /.
Nerv. & Ment. Dis.. 136:421, 1963.

Siegman, A. and Pope, B. : An Empirical
Scale for the Measurement of Therapist
Specificity in the Initial Psychiatric Inter-
view. Psychol. Rep.. 11:515, 1962.

Siegman, A. M. : A Cross-Cultural Investiga-
tion of the Relationship Between Introver-
sion-Extraversion, Social Attitudes and
.Anti-Social Behavior. Brit. J. Clin. Soc.
I'sychol., 1963. In press.

Siegman, A. W. : A Cross-Cultural Investiga-
tion of the Relationship Between Religiosity,
Ethnic Prejudice and .Authoritarianism.
Psychol. Rep., 11:419, 1962.

Vidaver, R. M. : Post Alcoholic Psychosis Re-
port of Four Cases with Unusual Ciiaractcr-
i.^^tics. .\filit. .Med.. 127:276, 1962.

Weintraub, W. : The Use and Misuse of
Tranquilizers. Mod. Med.. 1962.

Weintraub, W. and Aaronson, H. : Clinical
Judgments in Psychopharmacological Re-
search. /. Neuropsychiat. In press.

April, 1964

BULLETIX OF THE SCHOOL OF MEDICINE, UAirERSITV OF MARYLAND

Weixtralb, W. : The V'lP Syndrome. A Clin-
ical Study in Hospital Psychiatry. /. Ncrv.
& Mciit. Dis. In press.

Westox, D. L. : Utilizing Psychoanalytic Con-
cepts in Evaluation of the Pre-School Re-
tarded Child. Mental Defectives, 1963. In
press.

DEPARTMENT OF RADIOLOGY

Dexxis, J. M., WoLFEL, D. A., and Youxg,
J. D. : Diagnosis of Renovascular Hyperten-
sion : Role of the Radiologist. Radiologic
Clinics of North America, Vol. I, April,
1963.

Bloedorx, p. G. : Radiation and Surgery in
Progress in Radiation Therapy, Vol. II.
Grune & Stratton, Inc., New York, 1962.

Bloedorx, p. G., Youxg, J. D., Cuccia, C. A.,
Mercado, R., Jr., and Wizenberg, M. J. :
Radiotherapy in Carcinoma of the Bladder ;
Possible Complications and Their Preven-
tion. Radiology, 79:576, 1962.

Bloedorn, p. G. : Tumor Clinic Conference.
Cancer Bull, 15:37, 1963.

Lyon, James A., Jr. : Pneumomediastinum in
the Newborn. Radiologic Clinics of North
America, April, 1963.

WoLFEL, D. A. : Leimyosarcoma of the Esoph-
agus. Anicr. J. Roentgenol., Vol. 89, Janu-
ary, 1963.

WoLFEL, D. A., AxToxius, J. I., and Cowley,
R. A. : Posterior Mediastinal Lymph Node
Hyperplasia. Amer. J . Roentgenol. In press.

DEPARTMENT OF GENERAL SURGERY

BuxTox, R. W., Oda, F. T., McLaughlix, J.
S., Yeager, G. H., and Mansberger, A. R.,
Jr. : Vascular Anomalies of the Extremities
Associated with Abnormal Growth. Amer.
Surg., 28:775, 1962.

Buxton, R. W., Blair, E., Cowley, R. A.,
and Maxsberger, A. R., Jr.: Physiologic
Rationale for Hypothermia in Septic Shock.
ACS Surgical ForJini, Vol. XIII, 1962.

Buxton, R. W., Oda, F. T., Andrews, G. A.,
Bigelow, R. B., and Sitterson, B. W. :
Surgery in Patients with Leukemia and
Lymphoma. Amer. Surg., 29:33, 1963.

Buxton, R. W., Leveque, T. F., and Reyn-
olds, B. L. : Metabolic Responses in Skeletal
Muscle and Connective Tissues to Open Skin
Wounds in Animals. Amer. Surg., 29:48,
1963.

BuxTox, R. W., Revxolds, B. L., and
Leveque, T. F. : Metabolic Parameters in
the Healing of Open Skin Wounds in Ani-
mals. Amer. Surg.. 29:325, 1963.

Buxton, R. W. : Biological Research. Mary-
land M. J.. 12:140, 1963.

BuxTox, R. W. and Holdefer, W. F., Jk. :
Mycotic Aneurysm — Case Report, tinier.
Surg., November, 1963.

Buxton, R. W. and Reynolds, B. L. : Aber-
rations Produced in Healing Regenerating
Tissue by Exogenously Administered Tes-
tosterone, Hydrocortisone, and Methandro-
stenolone. Amer. Surg. In press.

Cuxnixgham, R. M. : The Plight of the Small
Hospital. /. Med. Education, No\. 37, July,
1962.

Cuxxixgham, R. M. : Education and Health
in Latin America. J. A.M. A., 1963. In press.

Cox, E. F. : Excision of Branchial Sinus and
Fistula Tracts Using Arterial Internal Strip-
pers. Surg. Gynec. & Obstct., 1963. In press.

Flotte, C. T. : Dextran in Treatment of
Thrombophlebitis. Trans. Southern Surg.
Assoc, 1962.

Flotte, C. T. : The Aledical Library. Maryland
Med. J., January, 1963.

Holdefer, W. F., Jr. and Yeager, G. H. : Sur-
gical Considerations in Peripheral Vascular
Disease. Anicr. Surg.. 28:411, 1962.

Just-Viera, J. O., JuRF, A., Lewers, D. T.,
and Yeager, G. H. : The L^se of Radiopaque
Emboli in Experimental Pulmonary Embol-
ism. Bull. Sch. of Med. Univ. Maryhmd,
47:59, 1962.

Just-Viera, J. O., Yeager, G. H., and Puron,
R. : Control of Hemorrhage from the Liver
Without Use of Sutures or Clamps. Amer.
Surg., 28:754, 1962.

Just-Viera, J. O. and Yeager, G. H. : Mas-
sive Lethal Pulmonary Emboli. Surgery,
53:109, 1963.

Just-Viera, J. O., Lewers, D. T., and Yeager,
G. H. : New Tissue Adhesives : Experimental
Application of Rapidly Polymerizing Plas-
tics. Maryland Med. J., 12:141, 1963.

Just-Viera, J. O., and Yeager, G. H. : Preven-
tion of Thrombosis in the Inferior Vena
Cava. Surg. Gynec. & Obstet., October, 1963.

Just-Viera, J. O., Lewers, D. T., and Yeager,
G. H. : Lethal Pro])erties of a Rapidly Poly-
merizing Adhesive Used for Nonsuture Sur-
gery. Arch. Surg. In press.

Just-Viera, J. O. : Clubbed Digits. An Enig-
ma. Arch. Intern. Med., 1963. In press.

Vol. 49, No. 2

MEDICAL SCIIOUL SECTION

JisT-ViERA, J. O., Yeager, G. H., and Puron,
K. : Experimental Control of Renal Hemor-
rhage by Use of a Rapidly Polymerizing
Adhesive, 'fniiis. Sciithcni Sur;/. Soc. 1963.
In press.

Mansbekger, a. R., Jr. : Ammonia \'alue in
Acute Abdominal Pain. Mod. Med.. Vol. 30,
September, 1962.

Mansberger, .\. R., Jr., Blair, E., Cowi.ey,
R. A., and BrxTOX, K. W. : Physiologic Ra-
tionale for Hyperthermia and Septic Shock.
ACS Surgical Ennnii. 1962.

Maxsberger, a. K., Jr.: Value of Peritoneal
Fluid Ammonia Levels in the Differential
Diagnosis of the Acute Abdomen. Rcz'ictv of
Surgery, Vol. 19, Se|)tember-October, 1962.

Mansberger, A. R., Jr., Ooa, F. T., Mc-
Laughlin, J. S., Yeager, G. H., and Bux-
ton, R. W. : Vascular Anomalies of the
Extremity Associated with Abnormal
Growth, .liner. Surg., Vol. 2(S, December,
1962.

Mansberger, A. R., Jr., and Kopilnick, M. :
Ammonia Determinations on Peritoneal
Fluid Value in Differential Diagnosis of
Acute Abdominal Disease. Clinical Study
\vith Case Reports. Maryhntd Med. J.. \'oI.
12, April, 1963.

Mansberger, A. R., Jr., Tountas, C. T.,
Travasano, F. J., Jules, A., and Weather-
i.v, D. L. : The Value of Ammonia Deter-
minations in Acute Intra-. Midominal Dis-
ease. .\n fixperimental Study. Maryland
Med. J.. \'ol. 12, April, 1963.

Mansberger, A. R., Jr. and Moore, G. E. :
Chemotherapy as an Adjuvant to Surgery.
Amcr. J. Surg., Vol. 105, May, 1963.

McLaughlin, J. S., Oda, F. T., Yeager, G.
H., Mansberger, A. R., Jr., and Buxton,
R. W. : Vascular Anomalies of the Extrem-
ity Associated with Abnormal Growth.
Amer. Surg., Vol. 28, December, 1962.

Michaelis, M., Esmond, W. G., and Moul-
TON, G. A.: Effect of Hyperbaric Oxygena-
tion on Xoble-Collip Drum Shock in the
Rat. Bull. Sell. Med. Univ. Maryland. 47:42,
1962.

Michaelis. M. and Greisman, S. E. : Effect
of Catechol Amines During Traumatic Shock
in the Rat. /. Surg. Research. 1963. In press.
Oda, F. T., McLaughlin, J. S., Yeager, G.
H., Mansberger, A. R., Jr., and Bl'xton,
R. W. : Vascular Anomalies of the Extrem-
ity Associated with Abnormal firowtlL
.liner. Sure/.. Vol. 28, December, 1962.

Oda, F. T. Gibbs, W. D., and Andrews, G.
A. : Distribution of Radioisotopes in Tumors
of the Rat Liver. /. Nucl. Med., 4:18, 1963.

Ollodart, R. M. and Rose, M. R. : Antibodies
to 1-2 Nai)litlio(|uinone. Cancer Research,
July, 1962.

White, J. P.: Deiiiscence of Abdominal
Wounds. Jhill. St. Agnes Hospital, Balti-
more, 1963. In press.

\'eager, (i. H., and Holdefer, W. F., Jr. :
Surgical Considerations in Peripheral Vas-
cular Disease. Amcr. Surg.. 28:411, 1962.

"^'eager, (]. H., Just-Viera, J. O., Jure, A.,
Lewers, D. T. : The Use of Radiopaque
Emboli in Experimental Pulmonary Embo-
lism. Bull Sch. Med. Univ. Maryland. 47:59,
1962.

Yeager, G. H. and Just-Viera, J. O. : Control
of Hemorrhage from the Liver Without the
Use of Sutures or Clamps ; Preliminary Re-
port. Amer. Surg., Vol. 28, November, 1962.

Yeager, C. H., Oda, F. T., McLaughlin, J.
S., Buxton, R. W., and Mansberger, A. R.,
Jr.: Vascular Anomalies of the Extremity
Associated with Abnormal Growth. Amer.
Surg., Vol. 28, December, 1962.

"^'eager, G. H. and Just-Viera, J. O. : Massive
Lethal Pulmonary Emboli. Surgery, 53:109,
1963.

Yeager, G. H., Lewers, D. T., and Just-
Viera, J. O. : New Tissue Adhesives. Mary-
land .Med. /.. 12:141, 1963.

Yeager, (i. H., Lewers, D. T., and Just-
Viera, J. O. : Lethal Properties of a Rapidly
Polymerizing Adhesive Used for Non-
Suture Surgery. Arch. Surg., 1963. In press.

Yeager, G. H. and Ju.st-Viera, J. O. : Pre-
vention of Thrombosis in the Inferior Vena
Cava. Surg. Gyncc. & Obstet.. October,
1963. In press.

Yeager, G. H., Ju.st-Viera, J. O., and Puron,
R. : Experimental Control of Renal Hemor-
rhage by Use of a Rapidly Polymerizing
Adhesive. Trans. .'Southern Surg. .S'oe.. 1963.
In press.

Divi-sion of Neurologic Surgery

Thompson, R. K. : Head Injuries. .Maryland
Med. J.. March, 1963.

Division of Otolaryngology

Blanchard, C. L. and Borsaxyi, S. J.: Ioniz-
ing Radiation and the Ear. J..A.M..4.,
181:198, 1962.

Blanchard, C. L. and Borsanvi, S. J.:

April, 1964

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Asymptomatic Parotid Swelling and Isopro-
terenol. The Laryngoscope, 72:1777, 1962.

Blanch. \Ki), C. L.. BoRS.\NYr, S. J., and
Carter, J. F. : Frequency Distribution
Analysis of Heart Sounds. Hull. Scli. Med.
Univ. Maryland, 47:56, 1962.

Blanchard, C. L. and Borsanvi, S. J. : Moliile
Auditory Research Unit. Bull. Sell. .Med.
Univ. .Maryland. 48:24, 1963.

Blanchard, C. L. and Borsanvi, S. J. : The
Use of Computers in Auditory Research :
Evoked Auditory Potentials in Man. Tlie
Laryngoscope. In press.

BoRSANYi, S. J. and Blanchard, C. L. : Ioniz-
ing Radiation and the Ear. J. A.M. A.,
181:958, 1962.

BoRSANYi, S. J. : Glomus Jugulare Tumores.
The Laryngoscope. 72:1336, 1962.

Borsanyi, S. J. and Blanchard, C. L. :
Asymptomatic Parotid Swelling and Isopro-
terenel. The Laryngoscope. 72:1777, 1962.

Borsanyi, S. J. : Chronic Asymptomatic En-
largement of the Parotid Glands. Ann. Otol.,
71:857, 1962.

Borsanyi, S. J., Blanchard, C. L., and
Carter, J. F. : Frequency Distribution
Analysis of Heart Sounds. Bull. Sch. Med.
Univ. Maryland, 47:56, 1962.

Borsanyi, S. J.: Mobile Auditory Research
Unit. Bull. Sch. Med. Univ. Maryland,
48:24, 1963.

Borsanyi, S. J. : The Prevention of Carotid
Artery Ruptures Following Radical Neck
Dissection in Radiated Patients. EENT
Digest, March, 1963.

Borsanyi, S. J. : Vitamin A Deficient Diet and
Parotid Swelling. Sinai Hospital Journal.
In press.

Borsanyi, S. J. and Blanchard, C. L. : The
Use of Computers in Auditory Research :
Evoked Auditory Potentials in Man. The
Laryngoscope. In press.

Borsanyi, S. J. : Some Aspects of Auditory
Evoked Potentials in Man. A)ui. Otol. In
press.

Carter, J. F., Borsanyi, S. J., and Blanch-
ard, C. L. : Frequency Distribution Analysis
of Heart Sounds. Bull. Sch. Med. Univ.
Maryland, 47:56, 1962.

Division of Tlioracic Surgery

Attar, S., Esmond, W. G., and Cow lev, R.
A. : Hyperbaric Oxygenation in Vascular
Collapse. /. Thor. & Cardiov. Surg., Decem-
ber, 1962.

Attar, S. and Naib, Z. : Cytologic and Clin-
ical Study of Endobronchial Hamartoma.
nis. Chest. 41:468, 1962.
Attar, S., Cowley, R. A., and Hawthorne,
I.: Hemorrhagic Shock in Dogs Treated
with D- Aldosterone. .\ Study of Survival
Rate. ACS Surgical Forum. 13:22, 1962.
Attar, S., Tisciiler, M., Ta.mres, A., and
Cowley, R. A. : An Automatic Cardiac
Monitor-Pacer. Bull. Sch. Med. Univ. Mary-
land, 47:28, 1962.
Attar, S., Cowley, R. A., Esmond, W. G.,
Blair, E., and Hawthorne, I. : Combined
Therapy : Cobalt Teletherapy Surgery in the
Treatment of Bronchogenic Carcinoma. On-
tario Med. J., June, 1962.
Attar, S., Cowley, R. A., Esmond, W. G.,
Blair, E., and Hawthorne, I. : Electro-
cardiographic and Biochemical Studies in
Hemorrhagic Shock Treated with Hyper-
baric Oxygenation. Circulation. April, 1963.
Attar, S., Esmond, W. G. and Cow^ley, R.
A. : Hyperbaric Oxygenation in Medical and
Surgical Conditions : Application in Experi-
mental Vascular Collapse. Proc. 2nd Animal
.San Diego Sympos. on Biomedical F.ng.,
Tune, 1962.
Attar, S., Esmond, W. G., and Cowley, R.
A. : Hyperbaric Oxygenation in Experi-
mental Shock : Experimental Chamber De-
sign and Operation. Trans. Amer. Soc. for
Artificial Intern. Organs. Vol. VIII, 1962.
Attar, S., Blair, E., Cowley, R. A., and
Esmond, W. G. : Effets Metaboliques de
I'arret Circulatoire a differents Niveaux
d'hypothermie. Lyo)i Chir.. 58:534, 1962.
Attar, S., Cowley, R. A., Esmond, W. G.,
and Blair, E. : La Prevention de I'acidose
metabolique en chirurgie cardiaque par
rhypothermic profoude a grand debit. Lyon
Chir., 58:554, 1962.
Attar, S., Esmond, W. G., Blair, E., and
Cowley, R. A. : Anatomy of Peripheral
Ramification of the Cardiac Conduction
System. Circulation. April, 1963.
Attar, S., Esmond, W. G., Borges, F., Blair,
E., and Cowley, R. A. : The Use of Manni-
t(jl on Post-Perfusion Oliguria-Anuria.
Cardiovasc. Surg., 6:699, 1962.
Attar, S., Es.mond, W. G., Blair, E., and
Cowley, R. A. : Autoclavable Reusable
Plastic Convoluted Disc Oxygenators for
Extracorporeal Perfusion Systems. Amer.
.Surg., 1963. In press.
Attar, S., Gutierrez, G., Esmond, W. G., and

J'ol. 49, No. 2

MEDICAL SCHOOL SECTION

Cowley, R. A. : Hyperbaric Oxygenation in
Massive Pulmonary Embolism. Dis. Chest,
1963. In press.

Attar, S., Esmond, W. G., Bi.aik, E., and
Cowley, R. A. : Experimental Aspects of
the Use of Hyperbaric Oxygen in Hemor-
rhagic Shock. Amcr. Surg., 1963. In press.

Attar, S. and Cowley, R. A. : Hemangioma
of the Mediastimum — Collective Review.
Amcr. Surg., 1963. In press.

Attar, S., Blair, E., Cowley, R. A., and
Esmond, W. G. : The Effect of Hypother-
mia on Circulatory Reflexes in the Human.
Surg. Gyncc. & Ohstct., 1963. In press.

Attar, S., Nygren, E., Cowley, R. A., Es-
mond, W. G., and Blair, E. : Morphologic
Changes in Experimental Myocardial In-
farction. Proc. IV IVorld Cong, on Cardiol..
1963. In press.

Attar, S., Blair, E., Cowley, R. A., and
Esmond, W. G. : The Significance of
Sampling Sites in Myocardial Metabolism
in Experimental Acute Coronary Occlusion.
Circulation. 1963. In press.

Attar, S., Esmond, W. G., Weaver, J.,
Chyba, J., Lewitinn, a., and Pierce, L. :
A Comparative Evaluation of Three Dis-
posable Heat Exchanges for Profound
Hypothermia. Proc. 13th Annua! Conf. Eng.
Med. & Biol., 1963. In press.

Blair, E., Cowley, R. A., Mansberger, A. R.,
Jr., and Buxton, R. W. : Physiologic Ra-
tionale for Hypothermia in Septic Shock.
ACS Surgical Forum, 13:20, 1962.

Blair, E., Cowley, R. A., Attar, S., and
Esmond, W. G. : Effets Metaboliques de
I'arret Circulatoire a differents Niveaux
d'hypothermie. Lyon Chir., 58:534, 1962.

Blair, K., Cowley, R. A., Esmond, W. G., and
Attar, S. : La Prevention de I'acidose meta-
boli(|ue en chirurgie cardique par I'hypo-
thermie profoude a grand debit. Lyoi Chir.,
58:554, 1962.

Blair, E., Attar, S., Esmond, W. G., Borges,
P., and Cowley, R. A. : The Use of Manni-
tol on Post-Perfusion Oliguria-Anuria. Car-
diova.s-c. Surg., 6:699, 1962.

Blair, E., Cowley, R. A., Attar, S., and
Esmond, W. G. : Electrocardiogra])hic and
Biochemical Studies in Hemorrhagic Shock
Treated with Hyperbaric Oxygenation. Car-
diovasc. Surg.. 6:670, 1962.
Blair, E., Cowley, R. A., Attar, S., Linberg,
E. J., and Bloedorn, F. : Combined Therapy :
Cobalt Teletherapy Surgery in the Treat-

ment of Bronchogenic Carcinoma. Ontario
Med. J., June, 1962.

Blair, E., Cowley, R. A., Attar, S., and
Esmond, W. G. : The Significance of Samp-
ling Sites in Myocardial Metabolism in E.x-
])erimental Acute Coronary Occlusion. Cir-
culatii))!, 1963. In press.

Blair, E., Esmond, W. G., Attar, S., and
Cowley, R. A. : Autoclavable Reusable
Plastic Convoluted Disc Oxygenators for
Extracorporeal Perfusion Systems. Amer.
Surg.. 1963. In press.

Blair, E. : Cold Therapy in Bacteremic Shock.
Proc. r Conf., Arctic Med., 1963. In press.

Blair, E., Nygren, E., Cowley, R. A., Es-
mond, W. G., and Attar, S. : Morphologic
Changes in Experimental Myocardial In-
farction. Proc. IV World Cong. Cardiol.,
1963. In press.

Blair, E., Cowley, R. A., Attar, S., and
Esmond, W. G. : The Effect of Hypothermia
on Circulatory Reflexes in the Human. Surg.
Gyncc. & Ohstct., 1963. In press.

Blair, E., Gutierrez, G., Esmond, W. G.,
Attar, S. and Cowley, R. A. : Hyperbaric
Oxygenation in Massive Pulmonary Em-
bolism. Dis. Chest, 1963. In press.

Blair, E., Esmond, W. G., Cowley, R. A., and
Attar, S. : Experimental Aspects of the Use
of Hyperbaric Oxygen in Hemorrhagic
Shock. Amer. Surg., 1963. In press.

Cowley, R. A., Esmond, W. G., Attar, S..
and Blair, E. : Anatomy of Peripheral
Ramification of the Cardiac Conduction Sys-
tem. Circulation, April, 1963.

Cowley, R. A., Esmond, W. G., Attar, S.,
Merlis, J. K., Scott, W. H., and Richards,
R. D. : Metabolic Hematologic and Neuro-
psychological Studies on Patients Under-
going Open Heart Surgery with Profound
Hypothermia. Proc. 22nd Inter. Cong. Phy-
siol. Sciences. 1962.

Cowley, R. A., Esmond, W. G., and Attar, S. :
Hyperbaric Oxygenation in Medical and
Surgical Conditions : .Applications in E.xjicri-
niental \'ascular Collapse. Proc. 2)id San
Diego Syml^os. Bioined. Eng.. 1962.

Cowi.EV, R. A., Esmond, W. G., and .Attar,
.S. : Hyperbaric Oxygenation in E.xperinicn-
tal .Sliock : E.xperimental Chamber Design
and Operation. Trans. Amer. Soc. Artificial
Int. Organs. Vol. VIII, 1962.

Cowley, R. A., Esmond, W. G., Attar, S.,
Blair, E., and Hawthorne, I. : Electro-
cardiographic and Biochemical Studies in

Af>ril. 1064

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Hemorrhagic Shock Treated with Hyper-
baric Oxygenation. Circulation. April, 1963.

Cowley, R. A., Attar, S., and Esmond, W.
G. : Hyperbaric Oxygenation in Vascular
Collapse. /. Thar. & Cardiov. Surg., Decem-
ber, 1962.

Cowi.Ev. R. A., LiNBERG, E., Attar, S., and
Blair, E. : Combined Therapy : Cobalt Tele-
therapy Surgery in the Treatment of Bron-
chogenic Carcinoma. Ontario Med. /., June,
1962.

Cowley, R. A., Blair, E., Mansberger, A. R.,
Jr., Buxton, R. : Physiologic Rationale for
Hypothermia in Septic Shock. ACS Surgical
Forum, 13:20, 1962.

Cowley, R. A., Blair, E., Attar, S., and
Esmond, W. G. : Effets Metabolique de
I'arret Circulatoire a differents Niveaux
d'hypothermie. Lyon Chir., 58:534, 1962.

Cowley, R. A., Esmond, W. G., Blair, E., and
Attar, S. : La Prevention de I'acidose meta-
bolique en chirurgie cardique par I'hypother-
mie profoude a grand debit. Lyon Chir.,
58:554, 1962.

Cowley, R. A., Attar, S., Esmond, W. G.,
Borges, F. G., Blair, E. : The Use of Man-
nitol on Post-Perfusion Oliguria-Anuria.
Cardiov. Surg., 6:699, 1962.

Cowley, R. A., Attar, S. and Hawthorne, I. :
Hemorrhagic Shock in Dogs Treated with
D-Aldosterone. A Study of Survival Rate.
ACS Surgical Forum, Vol. XIH, 1962.

Cowley, R. A., Tischler, M., Tamres, A.,
and Attar, S. : An Automatic Cardiac Mon-
itor-Pacer. Bull. Sell. Med. Univ. Maryland.
47:28, 1962.

Cowley, R. A. and Blair, E. : Hypothermia
in Emergency Lung Resection. Dis. Chest,
1963. In press.

Cowley, R. A., Blair, E., Attar, S., and Es-
mond, W. G. : The Significance of Sampling
Sites in Myocardial Metabolism in Experi-
mental Acute Coronary Occlusion. Circula-
tion, 1963. In press.

CoW'LEY, R. A., Esmond, W. G., Attar, S.,
and Blair, E. : Autoclavable Reusable Plas-
tic Convoluted Disc Oxygenators for E.xtra-
corporeal Perfusion Systems. Amer. Surg.,
1963. In press.

Cowley, R. a., Esmond, W. G., Blair, E.,
Xygren, E., and Attar, S. : Morphologic
Changes in Experimental Myocardial In-
farction. Proc. IV World Cong, on Cardiol.,
1963. In press.

Cowley, R. A., Attar, S., Blair, E., and

Esmond, W. G. : The Effect of Hypothermia
on Circulatory Reflexes in the Human. Surg.
Gynee. & Obstct., 1963. In press.

Cowley, R. A., Baker, N., and Linberg, E. :
A Follow-up on Patients with Bronchogenic
Carcinoma Locally Cured by Preoperative
Irradiation. /. Thor. <Sr Cardiov. Surg., 1963.
In press.

Cowley, R. A., Weaver, J., Esmond, W. G.,
Chyba, J., Attar, S., Levitinn, A., and
Pierce, L. : A Comparative Evaluation of
Three Disposable Heat Exchangers for Pro-
found Hypothermia. Proc. 15th Annual Conf.
Eng. in Med. &■ Biol., 1963. In press.

Cowley, R. A., Gutierrez, G., Esmond, W.
G., Blair, E., and Attar, S. : Hyperbaric
Oxygenation in Massive Pulmonary Em-
bolism. Dis. Chest. 1963. In press.

Cowley, R. A., Esmond, W. G., Blair, E.,
and Attar, S. : Experimental Aspects of the
Use of Hyperbaric Oxygen in Hemorrhagic
Shock. Amer. Surg., 1963. In press.

Cowley, R. A. and Attar, S. : Hemangioma of
the Mediastinum — Collective Review. Amer.
Surg.. 1963. In press.

Esmond, W. G., Attar, S., Cowley, R. A.,
and Blair, E. : Anatomy of Peripheral Ram-
ification of the Cardiac Conduction System.
Circulation, April, 1963.

Esmond, W. G., Attar, S., Merlis, J. K.,
Scott, W. H., Richards, R. D., and Cow-
ley, R. A. : Metabolic, Hematologic and
Neuropsychological Studies on Patients Un-
dergoing Open Heart Surgery with Profound
Hypothermia. Proc. 2nd Sa)i Diego Syinpos.
Biovied. Eng., 1962.

Esmond, W. G., Attar, S., and Cowley, R.
A. : Hyperbaric Oxygenation in Experimen-
tal Hemorrhagic Shock : Experimental
Chamber Design and Operation. Trans.
Amer. Soc. for Artificial Intern. Organs.
Vol. VIII, 1962.

Esmond, W. G., Attar, S., Borges, F. J.,
Cowley, R. A., Hollingsworth, N., and
Blair, E. : Use of Mannitol in Post-Per-
fusion Oliguria-Anuria. Circulation, 1963.

Esmond, W. G., Cowley, R. A., Attar, S.,
Blair, E., and Hawthorne, I. : Electro-
cardiograi)hic and Biochemical Studies in
Hemorrhagic Shock Treated with Hyper-
baric Oxygenation. Circulation, April, 1962.

Esmond, W. G., Attar, S., and Cowley, R.
A. : Hyperbaric Oxygenation in Vascular
Collapse. /. Thor. & Cardiov. Surg., Decem-
ber. 1962.

Vol. 49, No. 2

MEDICAL SCHOOL SECTION

Esmond, W. G., Moulton, G. A., and Mi-
CHAEi.is, M.: Effects of Hyperbaric Oxy-
genation on Noble Collip Drum Shock in
the Rat. Bull. Sch. Med. Univ. Maryland,
47:42, 1962.

Esmond, W. G., Bi..\ik, E., Cowley, R. A.,
and Attak, S. : Effets Metaboliques de
I'arret Circulatoire a differents Niveaux
d'hypothermie. Lyon Cliir.. 58:534, 1962.

Esmond, W. G., Cowley, R. A., Attar, S.,
and Blaik, E. : La Prevention de I'acidose
metaboHque en chirurgie cardique par I'hypo-
therniie profoude a grand debit. Lyon Chir.,
58:54, 1962.

Esmond, W. G., Attar, S., and Cowley, R.
A. : Hyperbaric Oxygenation in Medical and
Surgical Conditions : Application in Experi-
mental Vascular Collapse. Proc. 2nd San
Diego Synipos. Biovied. Eng., 1962.

Esmond, W. G., Blair, E., and Cowley, R.
A. : The Significance of Sampling Sites in
Myocardial Metabolism in Experimental
Acute Coronary Occlusion. Circnkition, 1963.

Esmond, W. G., Blair, E., Cowley, R. A.,
and Attar, S. : Autoclave Reusable Plastic
Convoluted Disc Oxygenators for Extra-
corporeal Perfusion Systems. Aincr. Surg.,
1963. In press.

Esmond, W. G., Nygren, E., Cowley, R. A.,
Blair, E., and Attar, S. : Morphologic
Changes in Experimental Myocardial In-
farction. Proc. /F World Cong. Cardiol.,
1963. In press.

Esmond, W. G., Cowley, R. A., Blair, E., and
Attar, S. : The Effect of Hypothermia on
Circulatory Reflexes in the Human. Surg.
Gynec. & Obstet., 1963. In press.

Esmond, W. G., Gutierrez, G., Blair, E.,
Attar, S., and Cowley, R. A. : Hyperbaric
Oxygenation in Massive Pulmonary Em-
bolism. Dis. Chest, 1963. In press.

Esmond, W. G., Blair, E., Cowley, R. A.,
and Attar, S. : Experimental Aspects of the
Use of Hyperbaric Oxygen in Hemorrhagic
Shock. Amer. Surg., 1963. In j)ress.

Hawthorne, I., Cowley, R. A., and Attar,
S. : Hemorrhagic Shock in Dogs Treated
with D-Aldosterone. A Study of Survival
Rate. ACS Surgical Porum. Vol. XIII, 1962.

Hawthorne, I., Cowley, R. A., Esmond, W.
G., Attar, S., and Blair, E. : Electrocardi-
ographic and Biochemical Studies in Hemor-
rhagic Shock Treated with Hyperbaric
Oxygenation. Circulation, April, 1963.

Lixberg, E. J., Cowley, R. A., Attar, S.,

Blair, E., and Bloedorn, F. : Combined
Therapy : Cobalt Teletherapy Surgery in
the Treatment of Bronchogenic Carcinoma.
Ontario Med. J., June, 1962.

Linberg, E. J. : Initial Care of Patients with
Blunt Chest Trauma. Maryland Med. J.,
March, 1963.

Linberg, E. J. : Emergency Surgery for Mas-
sive Hemoptysis. Anicr. Surg., 1963. In
press.

Linberg, E. J., Baker, X., and Cowley, R.
A. : A Follow-up on Patients with Broncho-
genic Carcinoma Locally Cured by Preop-
erative Irradiation. /. Thor. & Cardial-.
Surg., 1963. In press.

Division of Urologic Surgery

Bormel, p. and Galleher, E. P. : Reversed
Peristalsis and Other Complications of
Ureteroileostomies. /. Urol., August, 1962.

FiSHMAN, A. and Taylor, W. N. : Leukemic
Infiltration of the Prostate. /. Urol., Janu-
ary, 1963.

Galleher, E. P., Jr. and Bormel, P. : Re-
versed Peristalsis and Other Complications
of Ureteroileostomies. /. Urol., August, 1962.

Galleher, E. P., Jr. : Common Urologic Dif-
ficulties of the Aged. /. Amer. Geriat. Soc.
In press.

Kiser, W. S., Young, J. D., Jr., and Mex-
DONCA, P. : Studies on Segmental Ischemia
in the Etiology of Hypertension. Trans.
Amer. Assoc. G. U. Surg., 1963.

Mendonca, p., Kiser, W. S., and Young,
J. D., Jr. : Studies on Segmental Ischemia in
the Etiology of Hypertension. Trans. Amer.
Assoc. G. U . Surgery, 1963.

Phillippidjis, p., Young, J. D., Jr., and
Naib, Z. M. : Exfoliative Cytology of a
Primary Fibrosarcoma of the Kidney. /.
Urol. In press.

Powder, J. R. and Young, J. D., Jr.: Flank
Cutaneous Ureterostomy and Uretero-ure-
teral Cutaneous Xeostomy. Nezv York Med.
J., July, 1963.

Young, J. D., Jr., Dennis, J. M., and Wolfel,
D. : Diagnosis of Renovascular Hyperten-
sion : Role of the Radiologist. Radiol. Clinics
of North America, April, 1963.

Young, J. D., Jr., Madeloff, M. S., Schwartz.
F. D., Borges, F. J., and Revell, S. T. R.,
Jr. : Differential Excretion of Sodium and
Water in Man. Arch. Surg., December, 1962.

Con't on p. xxii

April, 1^64

18974964

Ox February 26, 1964, Dr. Cyrus F.
Horine, Associate Professor of Surgery
in the School of Medicine since 1936,
died in Union Memorial Hospital. All
of his many students, friends, and asso-
ciates lament the passing of this able
surgeon with a warm and scintillating
personality. He loved the abundant life
of warm friendship and radiated charm
and kindness in his winsome smile.

Dr. Horine was born in Myersville,
:\Id.. in 1897. He attended the Univer-
sity of Maryland School of Medicine and
graduated in 1919. He became Dr.
Arthur 'Si. Shipley's first intern in
surgery. He served as resident surgeon
from 1920 to 1922. He enjoyed the
esteem of his colleagues and his capabili-
ties brought him increases in rank in the
Department of Surgery. In 1936 he l)e-
came Associate Professor and retained
that rank at the time of his death.

During his close association with the
Department of Surgery, Dr. Horine en-
gaged in several research projects. He
was gifted with an inquiring intellect
and more than 25 ])ublications resulted
from his researches. His work with the
late Dr. C. G. Warner, published in the
American Journal of Physiology on pul-
monary artery pressures, represented
the first time that pulmonary artery
pressures were measured in the closed
chest without disturbing the intrapleural
pressure.

Dr. Horine enjoyed an extensive sur-
gical practice. His patients loved him.

He was honest and humble and had an
unusual capacity for making the patient
feel that he had a high stake in getting
him w^ell. Among his many friends was
the late Dr. Frank C. Bressler. and it
was Dr. Horine who persuaded Dr.
Bressler to leave his fortune to the med-
ical school and establish the Bressler
Building and the Bressler Research
Fund. \\'e owe this great research oppor-
tunity that the school has enjoyed over
the ever-lengthening past to the persua-
sive influence of Dr. Horine and his
friend. Dr. Bressler.

Upon the death of Dr. Howard Bubert.
Dr. Horine became Medical Director of
the Maryland State Police. He was also
consultant physician to the State Roads
Commission.

Dr. Horine was a Presbyterian and
attended the First Church in Baltimore.
Like a suit of the finest fabric, he wore
his religion on the street, in the home,
in the office, and in the operating room.
It not only became him but adorned him.
^\'e who knew him closely are better
men because he walked among us in
loving kindness and mercy. We have
faith that somewhere, beyond the morn-
ing cloud, in the infinite azure of the
heavens, his kind and indomitable spirit
marches on, declaring, "I have fought a
good fight. I have finished my course,
I have kept the faith."

John C. Kraxtz. Tr-

Vol. 49. No. 2

W. i^ennebp leader

1905=1963

Dr. W. Kennedy Waller was born
in Oueenstown, Md., on September 6,
1905. He attended Washington College
Preparatory School and later. The
Franklin Day School in Baltimore, from
which lie was graduated in 1925. He
took his undergraduate work at Univer-
sity of Maryland, receiving his B.S.
degree in 1928, and his medical degree
in 1936 from the School of Medicine.

Dr. Waller interned at University
Hospital from 1936 to 193(S and was
assistant resident in medicine from 1938
to 1939. From 1939 to 1942 he held a
fellowship in medicine under Dr. Mau-
rice Pincoffs.

Dr. Waller entered the Army in 1942
and served with the University of Mary-
land Unit. 42nd General Hospital until

1944. when he was assigned to command
the Rehabilitation L^iit at Rockhampton
in northern Austraha. Dr. Waller was
discharged from the Army in 1945 with
the rank of Lieutenant Colonel.

He tlien entered the private practice
of Medicine in Baltimore and resumed
teaching duties in the Department of
Medicine at the University of Maryland,
with rank of Associate in Medicine in

1945. and was promoted to Assistant
Professor of Medicine in 1936.

Dr. Waller's first love was the clinical
practice of medicine, and to this end he
was indefatigal)le in liis devotion and
loyalty to raise the standards of medical
care. In the passing of Dr. \\\aller. medi-
cine has lost a master in the art of the
practice of medicine. His greatest attri-
bute was his ability to handle the
troubled, difficult, and burdened patient.
He was ever conscious of the ])o\ver of
research and science of medicine. l)ut he
never lost feeling for the (lualitv of man.

Time was never too short to listen to a
patient's complaints and he always ap-
peared to crowd more work into an
already busy day. He worked with such
enthusiasm and zeal that he gave the
impression that he had "... many miles
to travel before his sleep." The rewards
of his work were found in the Greek
definition of happiness : "The full use
of one's abilities along lines of excel-
lence."

The true evaluation of the merit of a
doctor is the relationship that exists be-
tween the doctor and his patients and
the esteem in which he is held by his
colleagues. I know of no doctor who
enjoyed a more sincere patient relation-
ship, and I know of no doctor who
rendered medical care to more doctors'
families.

Dr. W'aller was a member of the Bal-
timore City Medical Society, the Med-
ical and Chirurgical Faculty of Mary-
land, the American Medical Association,
the American Society of Internal Medi-
cine, the Maryland Society of Internal
Medicine, the Lister Society, and the
Splint Club.

Those of us who knew Kennedy have
lost a true friend and the medical pro-
fession has lost an able practitioner who
lived by the Hi])pocratic Oath.

With the termination of this phase of
his existence, we bid him farewell and
Mizpah. ^^'_^LTER E. Karfgin. M.D.

April. 1964

Pook J^ebietosi

Principles of Neurological Surgery by Loyal
Davis, M.D., and Richard A. Davis, M.D.
608 pp. illus. W. B. Saunders Co., Phila-
delphia, Pa. 1963. $15.00.

Similar to the authors' previous Principles
of Neurological Surgery, published 20 years
ago, their present text serves as an introduc-
tion to noviciates of this neurological discipline.

The contents include an e.xcellent introduc-
tory discussion on neurological examination,
localization, and diagnostic studies. The strong-
est clinical chapters deal with nervous system
neoplasia and recent adjuncts in treatment.
Cranial, spinal, and peripheral nerve tissues are
covered in 140 pages. Unfortunately, emphasis
on levels of consciousnes and progression of
lesions of surgical importance have not been
stressed. Neurosurgical problems of infection,
intractable pain, and such advances as basal
ganglia surgery are covered along with brief
mention of treatable congenital anomalies,
autonomic and cranial nerve surgery.

The whole realm of neurosurgery is broadly
covered. The authors have chosen a potpourri
of concepts perhaps uncritically presented
rather than a coherent single theory. This is
best illustrated in the chapter on head trauma
in which a multitude of sometimes conflicting
theories are given.

Perhaps the major criticism is the lack of
organization. Neither the chapters, paragraphs,
nor sentences are arranged in sequence. End of
the chapter references are sound witli few
pertinent omissions.

The illustrations are ample, clearly repro-
duced, and assist the authors' descriptions. The
print is large and readable.

In summary, this is a compact volume that
serves to acquaint the house officer and the
non-specialist with basic neurosurgical con-
cepts.

William Kraut, M.D.

Methods of Enzymatic Analysis, edited by
Hans-Ulrich Bergmeyer. Pp. 1064. Verlag
Chemie, GMBH, Weinheim/Bergstr., .\ca-
demic Press, New York and London. 1963.

Enzyme determinations may serve two pur-
poses : a) Analysis for substances can be made
highly specific without their prior isolation
when they are specific substrates for enzyme
reactions, b) Significant changes in enzyme
concentrations in serum and tissues occur in
many diseases ; therefore, determinations of
enzyme activities have diagnostic value. In
(.Treat Britain and in Europe the techniques
flowing from enzyme analysis have been used
much more than in this country. Clinical chem-
ists and clinicians in this country will, there-
fore, welcome this most up-to-date treatise
which gives a general survey of enzyme meth-
ods, of the theory involved, and of enzyme
kinetics.

Specifically, 116 substrates are mentioned, for
each of which a detailed method for enzymatic
analysis is described. Further, determination
methods for 33 enzymes are given as they are
most used in medicine, in food chemistry, and
in plant chemistry. Many authors have con-
tributed to this work, Europeans as well as
Americans.

This book is in one volume in abbreviation
of the classic work Methods in Enzymology,
edited by Colowick and Kaplan and for its
conciseness recommends itself to every clin-
ical laboratory.

Since cnzymology is a rapidly growing
branch of biochemistry, the volume is likely to
have many more editions. In the future, the
editors might well increase the usefulness of
tliis handbook by expanding the index. Litera-
ture references should be given in full, and an
author index should be added.

MORITZ MiCHAELIS

Vol. 49, No. 2

MEDICAL SCHOOL SECTION

Aids to Embryology by AI. B. L. Craigmylc.
6th edition ( London, Bailliere, Tindall &
Cox. 7 and 8 Henrietta St. W. C. 2.) 200
pp. The Wilhanis & Wilkins Co., Balti-
more, exckisive L'. S. agents. 1962. $3.00.

Aids to Embryology, one of 40 pocket-sized

volumes in the familiar "Aids to "

series, has been brought up to date in several
areas, particularly those dealing with chromo-
some numbers and with the placenta. Many
illustrations have been redrawn; some new
ones have been added. In a terse, but readable
style a surprising amount of embryologic in-
formation is condensed and reviewed in an
orderly fashion. Xot a te.xtbook of embryology,
this volume is a synopsis designed to assist
niedical students and graduates in preparing
for their various board examinations.

V. E. K.

A Synopsis of Gastroenterology. G. W.

Chandler. 192 pp., ill. The Williams and
Wilkens Co., Baltimore, Md., 1963. $7.00.

This synopsis would be of interest to several
groups of physicians : the generalist for the
l)urpose of narrowing the hiatus between his
knowledge and the recent advances made in
this area ; the niedical student and resident
rotating through gastroenterology as a sub-
specialty ; and possibly the internist interested
in reviewing the major facets of gastrointes-
tinal diagnostics and therapeutics in prepara-
tion for specialty boards. The book should not
be used by the medical student who has not
previously studied the pathology of gastro-
intestinal diseases.

The volume is w-ell organized and written
in the form of a general outline. Each chapter
discusses a different topic such as diseases of
a particular segment of the gastrointestinal
tract, liver, pancreas, gall bladder, peritoneal
cavity and mesentery. A single chapter is
devoted to melena and hematemesis, a common
gastrointestinal symptom, while another chap-
ter treats general intestinal diseases. Illustra-
tions are few and consist mainly of drawings,
charts and graphs. Other than minor omis-
sions, the basic concepts of gastroenterologic
diagnostics and therapeutics are conveyed to
the reader. The index is complete. There is no
bibliography.

Selvin Passen, M.D.

Fundamentals of Neurology by Ernest Gard-
ner, M.D. Pp. 349 with illustrations. W.
B. Saunders Co., Pliiladel])hia and Lon-
don, 1963. $6.25.

This book was not intended to be a textbook
of clinical neurology, its orientation being pre-
dominantly anatomical with considerable em-
phasis on normal physiology. The approach to
the subject is basic, dealing mostly with con-
cepts rather than presenting large numbers of
specific facts. No subject is discussed at length
and the intricacies of histologic neuroanatomy,
neurochemistry, and neurophysiology are avoid-
ed except for short chapters. Also included is
a concise section on embryology. Neurologic
dysfunction is alluded to in many places but
is not discussed at length and major pathologic
processes are mentioned only where they serve
to illustrate the anatomical and physiological
material presented. The line drawings, diagrams
and photographs are technically good and are
well chosen to complement the text, which is
easy to understand and quite readable. At the
end of most of the chapters are one or more
short biographical sketches of well know'n
contributors to neurological science, a device
which gives the reader a view of some of the
history and traditions of the subject. A glossary
at the end of the volume gives the origin of
many of the terms unfamiliar to the novice
and defines the terms which are unique to
neurology and likely to be unfamiliar to the
beginning student. The references are not
abundant but appear well chosen and the prac-
tice of giving a short description of their speci-
fic value makes them more useful than those
contained in many of the longer, more com-
plete bibliographies.

In the introduction the author states that
the book's purpose is to serve as a basis for
further and more detailed study of disease
of the nervous system. This premise is care-
fully followed. The text's usefulness to residents
and practicing physicians in the neurological
sciences is, therefore, limited. It would, how-
ever, be a valuable supplementary text for
courses in neuroanatomy and basic neurology
for medical students. The book might also
prove quite useful in the postgraduate education
of neurological and neurosurgical nurses or in
the training of such paramedical personnel as
physical therapists, to whom a basic under-
standing of nervous function is essential.

H0W.\RD M. WiSOTZKEY, M.D.

Atril. 1(^64

ABSTRACTS

of articles by
faculty and alumni

The Influence of Sodium-Free Solutions on
the Membrane Potential of Frog Muscle

Fibers — L. J. Mullins and K. Noda.
/. Gen. Physiol. 47:117, 1963.

The membrane potential of frog sartorius
muscle fibers in a CI- and Na-free Ringer's
solution when sucrose replaces NaCl is about
the same as that in normal Ringer's solution.
The K+ efflux is also about the same in the
two solutions but muscles lose K and PO4 in
sucrose Ringer's solutions. The membrane po-
tential in sucrose Ringer's solution is equal to
that given by the Nernst equation for a K+
electrode, when corrections are made for the
activity coefficients for K+ inside and outside
the fiber. For a muscle in normal Ringer's solu-
tion, the measured membrane potential is with-
in a few millivolts of Ek- This finding is com-
patible with a 1 :1 coupled Na-K pump. It is
consistent with either no coupling of Na efflux
to K influx, or a coupling ratio of 3 or greater.

Detection of Neonatal Jaundice — Martin K.
Gorten, M.D.

G. P. Jan. 1964, p. 101.

There are many causes of jaundice in the
newborn. Regardless of etiology, the true
emergency is the hyperbilirubinemia itself.
Bilirubin encephalopathy leads to irreversible
brain damage. Early detection of jaundice can
lead to prompt exchange transfusion and a
great reduction in incidence of kernicterus.
Early detection is aided greatly by proper
artificial lighting with fluorescent bulbs and
by blanching the skin with a glass slide or a
plastic stick.

Every newborn infant is potentially jaun-
diced. Varying degrees of jaundice are often
found, principally in premature infants. If
jaundice develops rapidly to an intense degree,
it is considered pathologic.

Severe jaundice in the newborn is consid-
ered an emergency calling for rapid and imme-
diate exchange transfusion. The bilirubin test
should be performed routinely and jaundice
should be searched for so as to discover the
condition at a very early time. Instructions for
a rapid jaundice check are given in detail,
accompanied by illustrations and classification,
and full color illustrations.

Immunological Studies with Group B Ar-
thropod-borne Viruses. II. Effect of
Prior Infection with Japanese Ence-
phalitis Virus on the Viremia in Hu-
man Subjects Following Administration
of 17D Yellow Fever Vaccine — B. H.
Sweet, C. L. Wisseman, Jr., M. Kitaoka,
and T. Tamiya
Aiucr. J. Trap. Med. &■ Ilyg. 11:562, 1962

The incidence of viremia following vaccina-
tion with the 17D strain of yellow-fever virus
did not differ appreciably in a group of human
subjects possessing prevaccination Japanese
encephalitis neutralizing antibodies as a result
of previous inapparent natural infection from
the incidence of viremia in control groups
possessing no prevaccination Group B arbor
virus antibodies. There may have been a slight
diminution in the level of circulating virus
among the subjects with prevaccination JE
neutralizing antibodies as compared with the
level in the control groups ; however, the num-
ber of uncontrolled factors which may have
influenced these measurements precludes a firm
conclusion on this matter.

Con't from p. xvii

Young, J. D., Jk., and Powder, J. R. : Flank
Cutaneous Ureterostomy and Uretero-
ureteral Cutaneous Neostomy. Xeic York
State Med. /.. July, 1962.

Young, J. D., Jr., Kiser, W. S., and Men-
Do.NCA, P.: Studies on Segmental Ischemia
in the Etiology of Hypertension. Trans.
. Inter. Assoc. G. U. Surgery. 1963.

■^'ouNG, J. D., Jr., Naib, Z. M., and Powder,
J. R. : Cytologic Diagnosis of an Early
(irossly "Invisible" Transitional Cell Car-
cinoma of the Renal Pelvis. /. Urol., April,
1963.

\'()rxG, J. D., Jr.: .\ Method of Ureterostomy
and Uretcro-ureteral Cutaneous Neostomy.
)','(/;- Book of Urology, 1962-63.

Wnxo. J. 1)., Jr., Phillippidjis, P. and Naib,
Z. M. : Exfoliative Cytology of a Primary
P'ibrosarcoma of the Kidney. /. Urol. In
press.

Vol. 49, No. 2

OFFICERS

President

Gibson J. Wells, M.D.

President-Elect

J. Howard Franz, M.D.

Vice-Presidents

Louis Daily, M.D.
Vincent Davis, M.D.
Archie R. Cohen, M.D.

Secretary

Francis J. Rorges, M.D.

Treasurer

Howard B. Mays. M.D.

Executive Director

William H, Triplett, M.D.

Executive Secretary

Mrs. Louise Girkin

Board of Directors

Theodore E. Woodward, M.D.
F. Ford Loker, M.D.
Nathan E. Needle, M.D.
Harold P. Biehl, M.D.
Rennert M. Smelser, M.D.
Joseph D'Antonio, ^LD.
William Supik, M.D.
Hugh McNally, M.D.
Emmanuel Schimunek, M.D.
Frank K. Morris, ^LD.

(cx-officio)
George H. Yeager, M.D.

(cx-officio)

Nominating: Committee
I'^RANK K. Morris, M.D.
George H. Yeager, M.D.
Harry Beck, M.D.
Louis C. Dobihal, M.D.
John F. Hogan, Jr., M.D.

Representatives to General
Alumni Council

Frank K. ^[oRRIS, NLD.
George H. Yeager. M.D.
William H. Triplett, ^LD.

Representatives, Editorial Board,

Bulletin

Harry M. Robinson, Jr., ^LD.
John F. Savage, M.D.
C. Vernon Williamson, >LD.
Gibson J. Wells, M.D.

(cx-officio)

Representatives, Advisory Board,
Faculty

Frank K. Morris, ^LD.
George H. Yeager, ^LD.

ALUMNI ASSOCIATION

SECTION

P r e s i d e n t's Letter

Fcllozv Medical Aluunii:

On vi.siting the campus of our Alma Mater, one is
amazed to see the varied and many complex changes
that have transpired in the physical set-up as well as in
the internal organization of the School of Aledicine.
Without realizing it, one contemplates all the many illus-
trious persons and important contril)utions to medicine
that have emanated from our heloved institution. We
have trulv l)een l)equeathed a legacy of which we can
be justly proud. It is our responsibility to see that this
tradition continues into the future. It is also a sobering
thought to realize that much of the support that made
it all possible had its origin in private financial resources.

With the present, we all are aware of the intricate
enormity of training medical students, and of continuing
our own education to be better physicians. The modern
day methods that enable us to attain these goals become
ever more elaborate and increasingly expensive. These
facts have permitted government to more and more
relentlessly engulf medical education. As physicians. I
believe we must e.xert every effort to forestall tliis
encroachment. Contril)utions from individuals as well
as private enterprise can do much to reverse this
direction.

A most illuminating special report on this sul)ject
recently apjieared in the A.M .A. Journal of January 4.
1964. \'ol. 1<S7, No. 1. This article is easy to read and
clarifies its points with lucid diagrams. Remember the
more we succumb to government hand-outs, the more
we become inextrical)ly indebted to this source. We
can go on griping, but it is mucli more important to do
something about it.

As Alumni what can we do ? First, convince industrv
that the education of a ])hysician is an excellent invest-

April, 1964

BVLLETIX OF THE SCHOOL OF MEDICINE. UNirEkSITV OF MARVLAXP

meat for its funds. Secondly, we can donate to the Stu-
dent Loan Fund (make checks payable to Medical
Alumni Association). These funds are most liberally
made available to worthy students, and repayment terms
are easy. Another suggestion is to send gifts to the
Endowinent Fund of the University of Maryland. These
monies are used solely for the School of Medicine. The
Frank C. Dressier Fund is an outstanding example.
This organization was fully descriljed in the July, 1963,
Bulletin. Another possibility is to send funds to the
AMA-ERF, and earmark them for our School of
Medicine. Let us determine to perform constructive
action on this problem, and the future will shine as
brightly for our Alma Mater as has the past.

Remember Maryland Medical Reunion Day, May 8,
196-1-! When you receive this Bulletin, the time will
be near and you will have all the necessary information.
I hope that many of you already have sent in your reser-
vations, insuring an outstanding and unqualified suc-
cess. Dr. Edward Cotter has performed a Herculean
job, and everyone is greatly indebted to him for his
tireless effort.

Your officers, members of the Board, and various
committees are eagerly anticipating greeting you all on
this gala occasion, and we assure you and your wi\'es a
warm and cordial reception.

Gibson J. Wells, M.D.
President

Vol. 49, No. 2

Medical Alumni Annual Meeting Combined
with Maryland Medical Reunion

Medical Alumni Association Combines Meeting with Annual Programs of University
Hospital Medical and Surgical Specialty Societies

Meetings to Take Place May 7, 8 and 9, 1964, on the Baltimore Campus

President Gibson J. Wells of the
Medical Alumni Association has an-
nounced a diverse program of great med-
ical and surgical interest to be held on
the campus beginning Thursday evening,
May 7, 1964. This year, the Medical
Alumni Association has combined with
the University of Maryland Surgical So-
ciety, University of Maryland Hospital
Medical Association, the Douglass Ob-
stetrical and Gynecological Society of the
University of Maryland, and the Univer-
sity of Maryland Pediatric Society in
promoting a three-day medical and sur-
gical program which will include the
annual meeting of the Medical Alumni
Association and its attendant functions.
This combination of scientific and social
events no doubt will prove a distinct
improvement on the non-unified and ir-
regular programs of the past.

Program in Miniature

Alumni desiring to attend these func-
tions may be assured of a hotel reserva-
tion by contacting the Medical Alumni
ofi^ce directly (PLaza 2-1100. Ext. 305)
or by writing to Mrs. Louise Girkin,
Executive Secretary of the Medical
Alumni Association.

The ])rogram will liegin on Tluirsday,
May 7, at 8 :30 P.M.. with the Hospitality
Center in the Caswell Room of tlie Lord
l^)altimore Hotel. Registration will lak'e
place on Thursday, May 7, at the Lord
Baltimore Hotel and on Friday. May 8.
in the Health Sciences Librarv. Lombard

and Greene Streets. The entire program
follows.

Medical Alumni Association Activities
Friday, May 8, 1964

General Assembly, Health Sciences
Library Auditorium

A.M.

8 :45 Opening Remarks : Gibson J. Wells,
President
Welcome : William S. Stone, M.D.,

Dean
Address : "A Personal Account of the
Successful .American Assault on Mt.
Everest"
David L. Dingman, AI.D.

Assistant Resident in Surc/ery, Member .Va-
tional Geographic Mount Everest Expedition
1963

10 :00 Scientific Sessions

University of Maryland Surgical So-
ciety— Health Sciences Library Au-
ditorium

University of Maryland Hospital Med-
ical Association — Gordon Wilson
Hall

The Douglass Obstetrical and Gyne-
cological Society of the University
of Maryland — Psychiatric Institute
Room 1-704

University of Maryland Pediatric So-
ciety— Baltimore Union Building
Room 202

12:10 .\nnual Alumni Business Meeting. Chem-
ical Hall
Gibson J. Wells, M.D.. President .

Presiding
Presentation of .Alumni Honor Award
to Hugh R. Spencer, M.D., Class
of 1910, Baltimore Medical College

12:30 Luncheon, John Eager Howard Hall

2 :00 Scientific .Sessions

April, 1064

nVLLETIX' OF THE SCHOOL OF MRDKIXF. IWirnh'SrrV OF M.IN]'LAMJ

5 :30 Ci)cktail Party for 50-year graduates

Maryland Room, Lord Baltimore Hotel

6:30 Banquet. Ballroom, Lord Baltimore Hotel
Introduction of 50-year alumni and

recognition of Class of 1964
Speaker : "The Ideal Physician — His

Confused State in Today's World"

Jack C. Xorris, AI.D.

Dr. Xorris is Assistant Clinical Professor of
Pathology at Emory University, Atlanta, Ga.
He is a Fellow of the American College of
Physicians and the American Society of Clin-
ical Pathologists. He also serves as Chairman
of the \^'^orkmen's Compensation Medical
Board, for the State of Georgia. He is also
former President of the Fulton County Medical
Society, and Honorary Consultant of the
Armed Forces Institute of Pathology in Wash-
ington. He is a member of the New York
Academy of Sciences, an honorary admiral in
the Georgia Xavy, and a veteran of World
War I and II. He has a commission of Cap-
tain in the Medical Corps of the U. S. X'avy.
He is the author of "Gleanings From a Doc-
tor's Eye," "From Midnight to Daybreak,"
and "Blood on My Slides." He has also written
a volume entitled "An Autobiogra])hy of a
Practicing Pathologist."

Dancing to follow — Courtesy of the Med-
ical Alumni Association
Mel Sherr's Orchestra

11 -.2? "Some Technical Considerations in Rad-
ical Mastectomy"
Harry C. Hull, M.D.

Professor of Clinical Surgery
P.M.
12:00 Business Meeting

Moderator — Harry C. Hill, M.D.
2:00 "Polyps of the Gallbladder"
Robert W. Buxton, M.D.

Professor of Si(rcicry

Head. Dcfartmcnt of Siirycry

2 -.25 "Pre-Operative and Operative Evalua-

tion for Pelvic Exenteration"
EvKRARu F. Cox, M.D.

Assistant Professor of Surgery
2:50 "Cancer Chemotherapy for Head and
X'eck Malignancies"
XoRMAX Tarr, ]M.D.

Chief of Siiriierv

C.S.P.H.S. Hospital, Baltimore

3:15 "Cuff Tears of the Shoulder"

A. GiBsox Packard, Jr., M.D.

Assistant in Orthopedic Surgery

3 :40 "High Pressure Oxygen Therapy"

R. Adams Cowley, M.D.

Professor of Thoracic Surgery
Head, Division of Thoracic Surgery

Saturday, May 9, 1964

A.M. Tour of new University facilities

Visit Scientific Exhibits
P.M. Cocktails and dinner at Gibson Island

Club

Transportation will be provided

University of Maryland Surgical Society

PROGRAM

Friday, May 8, 1964
Health Sciences Library Auditorium

Moderator: Edwix O. Daue. M.D.

10 :00 "Recent Advances in Physiology and
Therapy of Refractory Shock"
Arlie R. Maxsberger, Jr., M.D.

Associate Professor of Surgery
10 :35 "Supervoltage Irradiation Followed by
Cystectomy for Bladder Cancer"
Earl P. Galleher, M.D.

Assistant Professor of Urology

11:00 "Peripheral Vascular Emergencies"

C. Thomas Flotte, M.D.

Associate Professor of Surgery

University Hospital Medical Association
Friday, May 8, 1964— Gordon Wilson Hall

Moderator: Willl\m T. Raby, M.D.

10 :00 "Detection of Malignant Lesions of the
Upper Gastrointestinal Tract and
Pancreas"
Howard F. Raskix, AI.D.

Associate Professor of Medicine
Head. Division of Gastroenterology

10 :20 "Bronchitis and Emphysema : The Role

of Environmental Factors in Patho-
genesis"
William S. Spicer, M.D.

Associate Professor of Medicine
Head, Division of Pulmonary Diseases

10:40 "Pulmonary Tuberculosis: Treatment of

the Uncomplicated Case"

Patrick B. Storey, M.D.

Associate Professor of Medicine

11 :00 "The Use of Countershock in the Treat-

Vol. 49, A-o. 2

ALUMNI ASSOCIATION SECTION

ment of Cardiac Arrhythmias: Selec-
tion of Patients and Hemodynamic
Changes"
Leonard Scherlis, M.D.

Associate Professor of Medicine
Head. Division of Cardioloyy

11:20 Panel — "Organic Brain Disorders Pre-
senting as Personality Problems"
El'HUAIM T. LiSAXSKV, AI.D.
Associate Professor of Medicine

Jerome K. Meri.is, M.D.

Professor of Xeuroloijy

Professor of Cli)iical Xeiirof'hysioloiiy

11 :.^() Business Meeting

Mddrratur : jonx Atkins, M.I).

P.M.

2:00 "The Lahoratory Control of Anticoagu-
lant Therapy"
Caruoi.i. L. Spurling, M.D.

Associate Professor of Medicine

2 :20 "The Concept of Auto-allergy and Hyy)-

ersensitivity in the Connective Tissue
Disorders"
Adalbert F. Schubart, M.D.

Associate Professor of Medicine
Head. Medical Outpatient Clinic
Head, Division of Arthritis

2 :40 "The Clinical Application of Xewer

Cheniotherapeutic .Agents"

Richard B. Hornick, M.D.

Assistant Professor of Medicine
Head, Dii'ision of Infections Diseases

3 :00 "The Basis of Treatment with Catecho-

lamines"
Sheldox E. Greismax, M.D.

Associate Professor of Medicine

3 :20 Panel — "Diagnostic Radioisotope Scan-
ning Techniques"
JoHx G. Wiswell, M.D.

Associate Professor of Medicine

Joseph B. Workman, M.D.

Associate Professor of Medicine
Head, Radioisotope Lahoratory

The Douglass Obstetrical and Gynecological
Society of the University of Maryland

Friday, May 8, 1964

Psychiatric Institute Room 1-704

Moderator: .Vktihk L. Haskixs, M.D.

A.M.

10:00 "Origins of 0\arian Tumors"
DoxAi.D G. McKay, M.D.

Professor and Chairman, Department of Path-
otofiy. College of Physicians and Surgeons,
( iiliimhia L'niversity

11 :00 "Fetal Effects of Maternal \'iral Disease"
Edith L. Potter, M.D.

Department of Obstetrics and Gynecology, The
Chicago Lyingin Hospital

Current Projects in the Department of
Obstetrics and Gynecology

Moderator: Kuiiard S. AIc.\i--oki), M.D.

2 :00 "Metastasizing Leioniyomata"
IIaxs D. Taubert, M.D.

I nstructor in Obstetrics and Gyneeology

2 :20 "Tumors of Mesonephric Origin in the
Female Genital Tract"
Umberto Villa Saxta, M.D.

Assistant Professor of Obstetrics and Gynecol-
ogy

2 :40 "Chiari Frommel Syndrome"
.\rthur L. Haskixs, M.D.

Professor and Head

Department of Obstetrics and Gynecology

3:10 "Pure (Gonadal Dysgenesis"

Erica F. Moszkowski, M.D.

Instructor in Obstetrics and Gynecology

3 :30 "Use of Stilbestrol for Ovulation Con-
trol"
Edmund B. Middletox, M.D.

Assistant Professor of Obstetrics and Gyne-
cology

University of Maryland Pediatric Society
Friday, May 8, 1964

A.M.

10 :00

Baltimore Union Room 202

Welcome

J. Edmuxd Bradley, M.D.

Professor of Pediatrics

Head, Department of Pediatrics

10:10 Organizational Meeting

Moderator: J. EoMfxn Bradley, M.D.
11:10 "Urinary Cortisol Metabolities in Nor-
mal Newborns and Infants of Dia-
betic Mothers"
Milton S. Grossmax, M.D.

Assistant Professor of Pediatrics
11:35 "Esophageal Abnorinalities in Infants
Demonstrated by Cine-radiograjjliy"
Eugene Blaxk, M.D.

Department of Radiology, Childroi's Hospital
of Pittsburgh

Moderator: .\. H. Fixkelsteix, M.D.

I'.M.

2 :00 "Ob.scure Causes of School Failure"
Raymond L. Clemmens, M.D.

Assistant Professor of Pediatrics
Director, Central Evaluation Clinic

2:25 "Studies on the Types of (iargoylism and

.\cid Mucopolysacchride E.xcretion"

Thomas A. Good, M.D.

Associate Professor of Pediatrics
2:50 ".Atypical Mycobacterial Infections in
Marvland Children"

. //T//. 1064

BULLETIX OF THE SCHOOL OF MEDICINE, UNirERSITV OF MARYLAND

Stuart H. Walker, M.D.

Associate Professor of Pediatrics
Chief, Department of Pediatrics,
Mercy Hospital

3:15 "Theory and Practice in Diabetes Melli-

tus"

Samuel P. Bessman, M.D.

Professor of Pediatric Research
Associate Professor of Biochemistry

3 :40 "Radiographic Abnormalities of the In-
fant's Pelvis"
James A. Lyon, Jr., M.D.

Associate Professor of Radiolotiy
Assistaut Professor of Pediatrics

Ladies' Activities

Thursday Evening, May 7, 1964

Wives are invited to join their husbands at
the Reception and Cocktail Party at the Lord
Baltimore Hotel.

a.m.
9:00

10:00

P.M.

12:30

Friday, May 8, 1964

Coffee and pastries will be served at the
Baltimore LTnion Building, 621 West
Lombard Street.

A bus tour of residential areas including
a conducted tour of the Cathedral, 5200
North Charles Street, and a walk through
the Sherwood Gardens. ( The bus will
leave the Baltimore Union Building at
10 A.M. and from the Lord Baltimore
Hotel at 10:15 a.m., promptly, for those
who wish to leave from this point.)

Luncheon, Sheraton-Belvedere Hotel,
Jubilee Room. Informal modeling of
clothes from Miller Brothers, 1110 North
Charles Street.

RESERVATIONS

The bus tour will cost $1.25 and the
luncheon, $3.25. Advance reservation is
necessary to provide adequately for the
group. Please use the enclosed reserva-
tion form to make your reservation and
return it with your check to the Medical
Alumni Office, University of Maryland
School of Medicine, Baltimore 1, Mary-
land, attention Mrs. Louise Girkin. An
early acceptance will be appreciated.
However, reservations will be honored
as late as May 1, 1964. If desired, tickets
will be held at the registration desk.

Mrs. James G. Arnold

Cluiiriiian

Committee

Mrs. James G. Arnold Mrs. Everett S. Diggs
Chairman Mrs. Leonard Scherlis

Mrs. Harry C. Bowie Mrs. Gibson J. Wells
Mrs. Edward F. Cotter

Mrs. Wilfred H. Townshend
Chairman of Fashion Shozc

Medical Alumni Association

OFFICERS
President: Gibson J. Wells. M.D.
President-elect: J. Howard Fraxz, M.D.
Vice-presidents: Louis Daly, M.D.

Vincent Davis, M.D.

Archie R. Cohex, M.D.
Secretary: Francis J. Borges, M.D.
Treasurer: Howard B. Mays, M.D.
Executive Director : WiLLiAsi H. Triplett, M.D.
Executive Secretary: Mrs. Louise Girkin

BOARD OF DIRECTORS
Theodore E. Woodward, M.D.
F. Ford Loker, M.D.
Nathan E. Needle, M.D.
Harold P. Biehl, M.D.
Rennert M. Smelser, M.D.
Joseph D'Antonio, M.D.
William J. Supik, M.D.
Hugh B. McNally, M.D.
Emmanuel Schimunek, M.D.
Frank K. Morris, M.D.

( ex-officio)
George H. Yeager, M.D.

( ex -officio)

University of Maryland Surgical Society

President: Harry C. Hull, M.D.
Vice-president: Edwin O. Daue, M.D.
Secretary-Treasurer :

Arlie R. AIansberger, Jr., M.D.

University of Maryland Hospital Medical
Association

President: William T. Raby, M.D.
Vice-president: John Atkins, M.D.
Secretary: James R. Karns, M.D.
Treasurer: Harry M. Robinson, Jr., M.D.

The Douglass Obstetrical and Gynecological
Society of the University of Maryland

President: J. Tyler, Baker, M.D.
Vice-president: Harry Cohen, M.D.
Secretary-Treasurer :

Edmund B. Middletox. M.D.

Con't on p. xx.x

J'nl. 49, No. 2

ALUMNI ASSOCIATION SECTION

Medical and Chirurgical Faculty of

Maryland To Hold 166th Annual

Meeting, May 6, 7, 8, 1964

Plans are now complete tor the an-
nual meeting of the Med-Chi to he held
at the Alcazar in Baltimore. The theme
of the \9()A meeting will be "Family
Physicians' Conference" and will not be
directed to the research worker.

This year highlights include an ad-
dress l)v Dr. Robert R. Linton of the
Harvard Medical School who will speak-
on "Reconstructive Surgical Procedures
for ]\Iajor Obliterative Arterial Dis-
eases." The Finney Lecture will feature
Dr. Isidore Cohn, ]v., of Louisiana State
I'niversity. who will speak on "Recur-
rence of Carcinoma After Colon Sur-
gery." Dr. Fdward R. Annis. President
of the American Medical Association,
will highlight the Presidential Dinner on
Wednesday, ]\Lav 6.

Dr. Milton .S. Sacks of the L'niversit\-
of Maryland will speak on "Hemato-
logical As]:)ects of Progress of Diseases
of a Medical Nature."

An Acknowledgment

At tiik kxd of each issue of the Bul-
LKTix is an .Mumui Xews Report Form.
We are now receiving (|uite a few of
these each week, nearly all of them con-
taining important professional news of
graduates of the School of Medicine. The
stafif of the Bulletin thanks you for
your cooperation.

It is most im])ortant that we record
the i)r()fessi()ual achievements of our
Alumni and it is therefore of great inter-
est to us that more of you are tearing
out the form and are sending us infor-
mation on vourself or other Alumni of
whom von have recent news.

Our com])liments and thanks.

Senior Alumni to be Featured on
Occasion of Annual Meeting, May 8

Specl\l invitations have been issued
by the Medical Alumni Association to
the senior alumni, graduates of 50 or
more years, hoping that they will return
to the campus for the festivities on May
7. 8. 1964.

The usual annual business meeting.
the award of the Alumni Certificate and
Ciold Key to Dr. Hugh R. Spencer, and
the annual banquet will be features of the
Alumni part of the celebration. A fine
scientific program has been prepared by
the medical and surgical hospital spe-
cialty groups ; this is contained elsewhere
in this edition of the Bulletin.

Washington, D. C, Alumni Organize

The Lniversity of Maryland School
of ]\Iedicine Alumni Club for the greater
\\'ashington area was organized in Sep-
tember, 1963. The first meeting was held
in October.

On November 20, a luncheon meeting
was held in conjunction with the 31st
Amui.'d Scientific Assemblv of the D. C.
Medical .Society. It is planned to make
this luncheon an annual event at the
time of the annual meeting of the I). C.
Medical Society.

The following officers are serving for
a term of two years :

Dr. lr\ing Burka, President: Dr. Leo
T. Brown, I'iee-president ; Dr. Gerald D.
.Schuster, Seeretary-Treasurcr ; Drs. S.
Charles Jones, Benjamin Isaacson, and
lames T. Fstes, iiieiiibers of the Execu-
tive Coiniiiittee.

.\11 Alumni of the School of Medicine
I'niversity of Maryland who are prac-
ticing in the vicinity of Washington,
D. C, are ur<red to become members of

April. 1064

BULLETIN OF THE SCHOOL OF MEDICIXE. UNIJ-ERSITV OF .\f.lR)L.lXD

the club. Inquiries should be directed to ERRATUM

Dr. Gerald D. Schuster, 1918 K Street,
X.W'.. Washiuij^ton 6, D. C. ; telephone
Muleral 8-1280.

Class of 1939 Plans Program for
Alumni Day, May 9

In the July, 1963, IU'lletix by error,
the IUt.lktin reported the death of Dr.
Harold Sager. Dr. Sager writes:

"If you have not already done so,
please print a retraction of my demise."
(We do ])rint and with a])ologies —
Editor. )

W'k ark looking forward to seeing

you on the campus this coming May 7, <^""'* ^'■"•" »• ''"'''"

8, and 9. The following tentative pro- University of Maryland Pediatric Society

gram for the 25th Reunion of the Class Organizational ^Meeting

of 1939 will lie held on Saturday, May 9,
at a noon luncheon at the Student Union
Building on the Baltimore campus.

Committee on Arrangements and Scientific
Program

Edward F. Cotter, M.D., Chairman
We are extending cordial invitations g^^^^^. j Cornbrooks, Jr., M.D.
to all members of the Class of 1939 and C. Parke Scarborough, M.D.
their wives for this affair. W^e believe Medical Alumni Association

the after-lunch speakers will be interest- James R. Karns, M.D.

r 1 ,1 1 , 1 .ui ■ 1 1- Harrv M. Robinson, Jr., M.D.

nig tor both classmates and their ladies. ,^ t- -.ir n^ t^

Theodore E. Woodward, M.D.

The topics of our short luncheon talks University of Maryland Hospital Medical

to be presented under the title "What Association

Medical School Did Not Teach Us" will Thurston R. Adams, M.D.

1 "Tu 4- c 1 -inr-.i i. T- • " Harry C. Hull, M.D.

be : How to Succeed \\ ithout i rvitig, ^ ^ ^ , , ^

, _. „ . ^ ^ . ,-„ ,,,, ,. ' , Eugene T. Linberg, M.D.

by Dr. Frank S. Cole. 39 ; Medical and ^^^^^ r" mansberger, Jr., M.D.
Non-Medical Experiences in Foreign

Lands," by Dr. Edgar Bernian, '39; and University of Maryland Surgical Society
as this issue goes to press, we are at- Edmund B. Middleton, AI.D.
tempting to contact another famous The Douglass Obstetrical and Gynecolog-

classmate. Dr. Thomas Scott Sexton, '^al Society of the University of Mary-

Vice President and Chief Medical Direc- ,, .J^""^ ,, ^

c -Mf 1 n/r ,x-rT IvARi. H. Weaver, M.D.

tor of Massachusetts Mutual Life Insur- University of Maryland Pediatric Society

ance Co., who will speak on the topic, Mrs. James G. Arnold

"You Can't Take It With You or How Ladies' Activities

to Hide Money for Retirement."

25th Reunion Committee

Class of 1939, School of Medicine

Raymond M. Cunningham,
Chairman

Harry Beck

James Ceanos

Bernard Kleiman

Dexter Reiman

Ramsay Thomas

-^xx Vol. 49. No. 2

(^lass

NOTES

Elsewhere in this edition you zi'ill
find a "tear out" page, jor reporting
Alumni Nezvs to the Bulletin. This is
not an idle gesture.

Your achievements, fellow alumnus,
arc of interest to your classmates. They
constitute a rczvard to the faculty, are a
challenge to the younger physicians, and
are an item of prestige for the Univer-
sity. Please cooperate with us by for-
warding nezvs of yourself or a)iy aluiinius
to the Bulletin. Thank \ou.

P & S 1888

Jefferson Davis Bulla of Trinity.
N. C, has recently celel:)rated his 101st
birthday and has announced his firm in-
tention on continuing his very active
practice which incKides from 5 to 20
patients a day. According to the medical
newspaper Medical Tribune. Dr. Bulla
is a likely candidate for oldest physician
still in practice in the United States,
though he doesn't make that claim him-
self.

Dr. P)ulla states that in the earl)- days
it was hard work, very hard work as he
began practice in Randolph County.
North Carolina. At first he used a Texas
pony, after that he wore out two or
three buggy horses, two Model T I'ords.
and one Model A Ford. Dr. I'ulla does
not think he has any particular secret
for his longevity. His recipe for longev-
ity is "Absolutely none at all." TTe is in
good health himself, li.'ning had onlv one
major o])eration, a cholestectomv in 1942.
Dr. Bulla has no current plans for retire-
ment.

Class of 1904

William L. Funkhouser of 15 16th
.St., X.E., in Atlanta, Ga., is very active
in his general practice. Dr. Funkhouser
is ^7.

Class of 1934

Joseph Millett of 501 Fulton Ave.,
Hempstead, X. Y., serves as associate
attending physician in the Department
of Internal Medicine of the Meadow-
brook Hospital, a 600-bed county general
hospital of Nassau County, N. Y. Dr.
Millett has recently been elected Chair-
man of the Medical Board of the Mea-
dowbrook Hospital.

H. Lawrence Sutton of Hempstead,
N. Y.. serves as attending physician in
the Department of Psychiatry at the
Meadowbrook Hospital, Nassau County,
N. Y. Dr. Sutton has been named Vice
Chairman of the Medical Board.

Class of 1939

David L. Filtzer has announced the
removal of his ofiice to 4419 Falls Road
in Baltimore. Md.

Class of 1942

Louis O. G. Manganiello of Augus-
ta, Ga., has been a])pointed bv Governor
Sanders of Georgia as an Admiral of
the Georgia Navy and is serving as a
member of the Governor's staff.

Class of 1943

Harold Dillon of 2()') S. 19th St..
l'hiladel])hia, l*a., has been elected to
meml)ership in the .American Psychoan-
alytic Association.

Robert V. Minervini, of 330 Park
1 1 ill .\ve., ^'onkers, N. Y., has l)een cer-
tified in general surgery l)y the -American
Ptoard of Surgery. Dr. Minervini has
l)racticed surgery in Yonkers since hilv.

April, 1964

BULLETIN OF THE SCHOOL OF MEDICINE, UNIJ'ERSITV OF MARYLAND

1960, when he completed a four-year
residency in general surgery at the
Flower- Fifth Ave. Hospital in New York
City. He currently serves as an instruc-
tor in surgery at the New York Medical
College.

Class of 1944

Bryant L. Jones is actively connect-
ed with the cancer chemotherapy pro-
gram of the National Institutes of
Health. He is active in the collaborative
research phases of this project.

Class of 1946

Thomas C. McPherson is a member
of the staff of the Mead Johnson Co. at
Evansville, Ind.

Class of 1949

John A. Spittell, Jr., Consultant of
the Section of Medicine of the Mayo
Clinic and Assistant Professor of Medi-
cine at the Mayo Foundation, is the
author of an article entitled "Dissecting
Aneurysm (Dissecting Hematoma) of
the Aorta," published in the American
Heart Association's "Modern Concepts
of Cardiovascular Disease," 33:837-40
(Feb., 1964).

Class of 1950

Harold Daly of Albion, Mich., was
a recent visitor at the School of Medi-
cine.

Class of 1954

Anthony A. Bernardo of 130 Rock
St., Fall River, Mass., has been certified
in general surgery by the American
Board of Surgery. Dr. Bernardo resides
at 8 Driftwood Drive, Barrington, R. I.

David Looff has been appointed to
the staff of the new University of Ken-
tucky Medical School in the Department
of Psychiatry. Dr. Looff, who lives at
1308 Fincastle Rd., Lexington, Ky., was

on active duty in the U. S. Public Health
Service until July, 1962. In July, 1964,
he will take up full-time work at the
L'niversity of Kentucky as Assistant
Professor with specific responsibility for
exploring needs for child psychiatry in
certain pilot project communities in Ken-
tucky. Dr. Looff was certified in general
psychiatry in October, 1963.

Harold W. Tracey of 1822 Bruns-
wick Rd.. Charlotte. N. C, has been
certified in orthopedic surgery l)y the
American Board of Orthopedic Surgery.
Dr. Tracy is in private practice with the
Miller Orthopedic Clinic in Charlotte.

Class of 1956

C. Herschel King, anesthesiologist,
received his certification as a Diplomate
of the American Board of Anesthesiology
during 1963. Dr. King has been appoint-
ed Assistant Professor of Anesthesiology
at Duke University Aledical Center. He
assumed his new post on January 1.
1964. Dr. King will reside at 2622 Char-
lotte St., Durham. N. C.

Class of 1962

Allen H. Satou is serving a residency
in psychiatry at the L^niversity of Cali-
fornia in Los Angeles.

Class of 1963

Donald H. Gilden of 840 S. Wood
St., Chicago, 111., is serving his intern-
ship at the University of Illinois Hospi-
tals. Beginning on July 1, 1964, Dr. Gil-
den will serve as resident in the Depart-
ment of Medicine at the University of
Chicago Hospital and Clinics.

Michael L. Levin has accepted a
surgical residency at the University of
Illinois Research Education Hospitals
under the direction of Dr. Warren H.
Cole. Dr. Levin's current address is 840
S. Wood St. (Box 82), Chicago, 111.

Vol. 49, No. 2

B. M. C. 1897

David S. Morrill of Ivinnville. N. C,
died recently.

Class of 1901

Carl R. Ahroon of Normal, 111., died
on December 21, 1963.

B. M. C. 1903

Daniel Alfonso Dees of Grantsboro,
N.C., died September 19, 1963. Dr. Dees
was S3.

Class of 1903

Herbert E. La Roque, well-known
Baltimore ophthalmologist, died at his
home, 10 Cherry Hill Rd.. Reisterstown.
on December 11, 1963. Dr. La Roque
was 83.

A native of Baltimore, Dr. La Roque
received his basic education at Baltimore
City College and, after graduation from
the School of Medicine, L^niversity of
Maryland, studied abroad. For many
years he was associated with the l>alti-
more City Health Department and was
active on the stafif of the Mercy and St.
Joseph's Hospitals.

P & S 1904

Wilbur E. MacDougal of 186 Xow-
ell Rd., Bangor, Me., died recently.

Class of 1905

Sydenham Rush Clarke of 212 E.

Morris Ave., Lutherville, Md.. died
February 26, 1964, at the age of S7.

William H. Mitchell of Parma.
Idaho, died October 20. 1963. Dr. flitch-
ell was 84.

Class of 1906

Lafayette Lake of 45 Van Ness Rd.,
l)elmont, Mass., died recently.

B. M. C. 1908

Harry C. Podall of Norristown, Pa.,
died at Sacred Heart Hospital in Norris-
town, on Monday, February 17, 1964.
Dr. Podall was 81.

A native of New Haven, Conn., and
an alumnus of Yale University, Dr.
Podall specialized in Psychiatry follow-
ing his graduation from the School of
Medicine. In 1958 he was presented a
placjue by the Montgomery County Med-
ical Society in honor of his 50 years of
service to the community.

For a number of years. Dr. Podall was
on the staff of the Norristown State
Hospital, resigning to become chief of
Neuropsychiatry at the Veterans Admin-
istration Hospital in Philadelphia. Later
he assumed a similar post at the Veter-
ans Hospital in Coatesville, Pa., where
he was chief of the Psychiatric Section
for almost 20 years. In 1952 he retired to
become clinical director at the Pennhurst
State School, Spring City. Pa., a post
he held at the time of his death. Dr.
Podall had also been Psychiatrist at the
Montgomery County Prison in Norris-
town. He was consultant in Neuropsy-
chiatry at the Montgomery Hospital and
Sacred Heart Hospital, both of Norris-
town.

Certified in both psychiatry and neu-
rolog\', he was a long-time Fellow of the
American Psychiatric Association and
the Pennsylvania State Psychiatric Asso-
ciation, and a member of the American
Medical Association, the Pennsylvania
State and Montgomery County Medical
Societies, and the Philadelphia Medical
Club. He was a member of the Yale
I'niversitv Alumni Association, the

Alyril. 1964

BULLETIX OF THE SCHOOL OF MEDICINE. UNIVERSITY OF MARYLAND

Alumni Association of the University of
Manland, and attended St. Patrick's
Clnn'ch in Xorristown.

Class of 1908

Herbert J. Rosenberg of 3433 Bank-
head Ave.. Montgomery, Ala., died
recently.

P & S 1909

Felix M. Vilella of 5754 S.W. 47th
St.. Aliami, Fla., died on January 24,
1964.

P & S 1910

Benjamin B. Finkelstone of

firidgeport, Conn., died recently.

Wilbert Lee Grounds of Roaring
Springs, Pa., died recently.

P & S 1911

Howard E. Harmon, a life-long res-
ident of Chillicothe, Ohio, was horn on
Decern! )er 14. 1888. He graduated from
Chillicothe High School in 1907 and
entered the College of Physicians and
Surgeons that year. Dr. Harman served
in hoth World Wars. He was a major
in the Medical Corps in World War I,
and in World War H was a Lieutenant
Colonel.

On June 8, 1961, he received a 50-year
])in from the University of Maryland,
and on Decemher 5 of that year received
a "50-year Award of Distinction" from
the Ohio State Medical Association.

He was a memher of the Elks, Kiwanis
Cluh, Masonic Lodge, and the Sons of
the American Revolution, Ross County
and Ohio State Medical Associations.
He was also a member of Chi Zeta Chi
Medical Fraternity which amalgamated
with Phi Rho Sigma years later.

John Hogan, Sr., M.D.

Class of 1914

Capt. John Robert Agnew of 2>7

Eckington St., Springfield, Mass., died
December 7, 1963.

Clair Crouse Henderson of Mt.
Olive, X. C, died on October 8, 1963.
Dr. Henderson was 75.

Raymond M. Troxler of 517 Foun-
tain Place, Burlington, X. C, died
August 5, 1963. Dr. Troxler was 78.

Class of 1915

Edgar Winslow Lane of 122 Fla-
mingo Rd., Clearwater, Fla., died in
October, 1963.

Albert Augustus Naumann of 4828
Bayville Ave., Tampa, Fla., died recently.

Class of 1916

Everett L. Bishop of Medical Arts
Bldg., Atlanta, Ga., died on August 12,
1963, at the age of 70.

Toma's Dominguez of Puerto Rico

died in Octol)er, 1963, of heart disease.

Julio R. Rolenson, a native of Ponce,
Puerto Rico, died at his home in San-
turce, Puerto Rico, on October 17, 1963.
Death followed the complications of
coronary occlusion.

Following his graduation. Dr. Rolen-
son interned at the Maryland General
Hospital and then joined the armed
forces serving in the medical corps of the
American Expeditionary Forces in
France. He was discharged with the rank
of Captain. He later married Ana Teresa
Ballan. Dr. Rolenson was a member of
the Puerto Rico Medical Association,
the American Legion, and a very active
meml)er of the University of Maryland
Alumni Association, having served as
Past President of the Puerto Rico chap-
ter.

Vol. 49. No. 2

PLEASE TEAR OUT

ALUMNI NEWS REPORT

TO THE BULLETIN:

I would like to report the following :

SUGGESTIONS FOR NEWS ITEMS

American Board Certification
Change of Address
Change of Office
Residency Appointment
Research Completed
News of Another Alumnus
Academic Appointment
Interesting Historic Photographs

Name

Address

Class

Send to

Bulletin — School of Medicine
University of Maryland
31 S. Greene St.
Baltimore 1, Md.

BULLETIN School of Medicine
University of Maryland

VOLUME 49

JULY, 1964

NUMBER 3

TABLE OF CONTENTS

ORIGINAL ARTICLES

PAGE

Esophageal Defibrillation of the Canine Heart, I

R. Adams Cou'lcy. M.D., Azruin T inures, and Morris Tischlcr, M.S.

Errata

Spinal Fluid Cytodiagnosis of Central Nervous System Malignancy (Preliminary Report).

Hiward M. Jns<>t::kcy, M.D.. and Riva Novcy, M.D.

Anesthesia LXVIII: Indoklon, A New Psychiatric Drug, and Its Sulfur Analog _ 36

Robert S. Rozman, Ph.D., R. Terrell, Ph.D., and John C. Krantz, Jr., Ph.D.

39
40

MEDICAL SCHOOL SECTION

Dean's Letter _

Pre-commencement and Dean's Day ..
Internships _

Faculty Notes Vi

Revolution and Renewal in Medicine _ vi

I'liiil J. Sa)iacaro, M.D.

Abstracts _ xl\

Book Reviews

ALUMNI ASSOCIATION SECTION

President's Letter — — Xvi

Alumni Day 1964 xix

Treasurer's Report of Alumni Association for 1963 xxiv

Minutes of Annual Meeting of Alumni Association xxv

Class of 1914 xxvii

Class Notes xxix

Deaths

JhIx. 1^64

Esophageal Defibrillation of the Canine
Heart, I*

R. ADAMS COWLEY, M.D., AVRUM TAMRES, and MORRIS TISCHLER, M.S.

Introduction

Cardiac defibrillation is usually ac-
coniplished by applying a potential either
directly on the heart or on the surface of
the intact chest. Neither method is the
optimal solution to the problem.

Open chest defil)rillation'- - of the
heart has been the more successful meth-
od of resuscitation but often it is not
feasil)le due to the location of the patient,
lack of necessary anesthesia ecjuipment.
and qualified surgical personnel available
at the critical moment. Furthermore,
thoracotomy without ventilation control
may only compound a distressful situa-
tion.

The closed chest techniciue of defibril-
lation-^ utilizes high voltage and high
power levels and requires large bulky
equipment with fifteen times more power
than instruments used for open chest de-
fibrillation. This excessive but necessary
power may cause thermal burns, severe
insult to the nervous system and cardiac
resuscitation is often unsuccessful.

The body acts as a low impedance path
when electrodes are placed under the
skin as compared with the im])edance
when electrodes are placed on the skin
surface. The impedance is three times
greater in the latter instance. If an elec-
trode could ])(■ ])laced near the lieart
through a natural ])ody orifice this im-
pedance miglit be overcome. The esoi)h-
agus was chosen as the most practical
and accessible site to place such an in-

* From the Department of Surgery, Division of
Thoracic Surgery, University of Maryland School of
Medicine, Baltimore 1, Maryland. Supported by Na-
tional Institutes of Health Research Grant H-4945.

ternal electrode. When placed in close
proximity to the heart, the electrode acts
as if it were touching the heart.

This paper describes a method where-
by low power defibrillators can be used
for either closed or open chest defil)rilla-
tion using an esophageal electrode in con-
junction with an external chest electrode.

Method of Approach

Experiments were performed on
healthy mongrel dogs to evaluate the
various techniques of cardiac resuscita-
tion. The animals were divided into three
groups : Group I — open chest defibrilla-
tion, Group II — closed chest defibrilla-
tion and Group III — esophageal elec-
trode defibrillation. All dogs received
pentobarbital sodium ( Nembutal So-
dium) anesthesia with tracheal intuba-
tion and intermittent positive pressure
breathing air. Arterial pressures and
electrocardiograms were monitored and
recorded throughout the procedure. Each
group of dogs was fibrillated by applying
60 cycle voltage directly to the heart. In
Group II and III, fibrillation was in-
duced by a needle probe through the
chest wall directly to the heart.

Results

/. Open Chest Procedure

In Group I, the dog's chest was opened
])rior to inducing fibrillation. To resus-
citate the animal, paddles 4 cm. in diam-
eter were placed directly on the heart.
The defibrillator used produced a square
wave with an amplitude of 1 50 volts and
o])erating at a frequency ranging between
150 and 250 cycles. The pulse duration
was 1/10 seconds.

Vol. 49, No. 3

2. Closed C'lirsf Procrdurc

In the closed chest techiii(|ne (Group
II j, 8 cm. paddles were placed on the
chest wall in the standard position. De-
file-illation was attempted with the same
defihrillator described above except the
amplitude had to be increased from 150
volts to 440 volts.

3. Esoplhiiiciil Electrode Procedure

In Group III dogs, an esophageal elec-
trode constructed from a No. 26 endo-
tracheal tube with a 3-inch braided cop-
per wire mesh surrounding the tip (Fig.
-1 ) was inserted with the mesh wiring
in the extended position to the approxi-
mate level of the heart. While holding
the catheter in position, a wire stylette
connected to the mesh was pulled, there-
by causing the mesh to contract and
hence increasing the diameter of the
mesh. Firm contact was herebv made
with the wall of the esophagus. A second
8 cm. paddle type electrode was placed
on the dog's chest, directly over the
heart. In this position the most direct
electricrd path was made through the
cardiac muscle. The defibrillator used
was the same model as that used in both
Groups I and II, however, an amplitude
of only 200 volts was required. Table I
summarizes the study. It appears that
the esophageal electrode technique is the
least ecpial in elTectiveness to that used
in the open chest technique.

Table I

Xn. (if Successful

Experi- Attempts

ments At Resuscitation

Technique of Voltage

defibrillation Number Number Percent Used

Open Chest
(Group I)

Closed Chest
(Group II )

Esophageal
(Group III)

24 24 100% 150

10 7 70^; 440

40 39 *97.57o 200

* In Group III, one of the animal's heart fibrillated
for four minutes 19 seconds. After fibrillation the
electrocardiogram returned to a sinus rhythm but
arterial pressure did not respond. This was not re-
corded as a successful attempt at resuscitation.

Fig. 1. A — Plastic tube. B — Copper wire mesh.
C — Wire stylette. D — Current to mesh via stylette.
E — External Electrode. F — Esophagus. G — Heart.

Histological sections of esophagus
were taken several days following the
procedure. No tissue damage was ob-
served where the electrode came in con-
tact with the esophagus.

Conclusions

Closed chest defibrillation requires
high power type of defil)rillators. At the
])resent time, defibrillators operating at
5,000 watts (700 volts) and 5,000 volts
DC (capacitor discharge) are used.

A s])ecial type electrode, inserted in
the esophagus, was found to provide ef-
fective defibrillation when used with
much lower power instruments. While
the esophageal method has performed
effectively on animals, the technique has
yet to be applied to a human subject.

Bibliography

1. ZULL, P. M., LiXE.NTIIAL, A. J., GiBSO.V,

W., Paul, M. H., and Normax, L. R. : Termi-
nation of ventricular fibrillation in man by
(.■xtoriially applied electric countershock, Neic
lingUmd J. Med., 254:541, 1956.

2. Cowley, R. A., Tischler, M., Attar, S.,
T.x.MRES, A.: Cardiac defibrillation above 60
cycles with a portable square-wave defibrilla-
tor, Surgery, 51: No. 2, 1962.

3. KouwEXHOVEN, W. B., Milxor, \V. R.,
Knrkerbacker, G. G., and Chestxut, W. R. :
Cosed chest defibrillation of the heart, Sur-
ijcry, 42:550, 1957.

Julx. 1964

Anesthesia LXVII: Indoklon, A New
Psychiatric Drug, and Its Sulfur Analog*

ROBERT S. ROZMAN, Ph.D., R. TERRELL, Ph.D.** and JOHN C. KRANTZ, JR., Ph.D.

The accelerated search for pharma-
cologically active fluorinated compounds
initiated hv Rohl^ins^ in 1946 led to the
development of the anesthetic Fluoromar
(2,2,2-trifluoroethyl vinyl ether) at the
University of Maryland. The introduc-
tion of fluorine into the ether molecule
greatly reduced the flammahility of the
anesthetic. This suggested that the addi-
tion of more fluorine atoms to the diethyl
ether molecule and the elimination of
the doul)le l)ond would further decrease
flammahility. Thus, bis (pentafluoro-
ethyl ) ether was studied.- This com-
l)Ound was found to be pharmacologically
inert. Since Robbins had shown that
ethyl trifluoroethyl ether possessed anes-
thetic properties,^ the symmetrical hexa-
fluorodiethyl ether (HFE) was synthe-
sized. Surprisingly this compound was
shown to be a convulsant by Krantz ct
al.^ A comparison of the pharmacologic
activity of these diethyl ethers is given in
Table 1.

,_. 70 «

2 NaSH+CF.3CH>OS02<f >CH3-

Table 1. Comparison of Diethyl Ethers

Pharinacologic

Compound

Activity

CH3CH.OCH.CH3

Anesthetic

CF..CH.0CH,CH3

Anesthetic

CF.sCH.OCH.CF3

Convulsant

CF.CF.OCF.CF3

Inert

clinical tise by the Food and Drug Ad-
ministration.

As recently reported"* in an interview
with Dr. William Karliner, chief clinical
investigator of Indoklon, schizoaft'ective
disorders and paranoid states both re-
spond more to this drug than to electro-
conviflsive therapy. A series of 2.348
Indoklon treatments administered to
159 patients was described. Of these,
59 were "much improved." 93 were
"improved," while the remaining 7 were
not benefited by this treatment.

When the sulfur analog of Indoklon
was made available, it was deemed de-

<^~\i

Hexafluorodiethyl ether, now known
as Indoklon, was extensively investigated
in many species of animals. No toxic
effects were observed after many rej^eat-
ed exposures to the drug. Accordingly
this agent was tried as a pharmacocon-
\iilsive drug in })lace of shock tliera])y in
mentally disturbed patients. The success
and efficacy of this experimental drug
recently culminated in ajjproval for

^CF3CHo-S-CHoCF.3+NaOS02< >CH3

DMSO ^=^

+ H2S

sirable to compare the two agents phar-
macologically. Thioindoklon (HFTE)
was synthesized by the following
method.''

* From the Department of Pharmacology, t'liiver-
sity of Maryland School of Medicine, Baltimore.

** Research Chemist, Central Research Laliora-
tories. Air Reduction Comi)any, Inc., Murray Hill,
New Jersey.

A solution of 2,2,2-tritluoroethyl-i)-toluene
sulfonate (202 g) in dimethyl sulfo.xide
(200 ml) was added slowly at 70-80° C
over a period of one hour to a stirred
solution of sodium hydrosulfide (136 g of
commercial "NaSH -f- aq") in dimethyl
sulfoxide (300 ml). The reaction was
heated at 70° C for two hours, water ( 500
ml) was added and the product (77 g crude)
distilled from the reaction mixture (Pot.
up to 100° C). The crude product was

Vol. 49, No. 3

ROZM.-IX. ET AL.— ANESTHESIA LXl'II: INDOKLON, A PSYCHIATRIC DRUG
Table 2. Comparison of the Physical Properties of HFE and HFTE.

HFE

HFTE

Formula

CFaCHo-O-CHaCF.,

CFsCHs-S-CH^CFa

Appearance

clear, colorless

liquid

clear, colorless liquid

Molecular weight ....

182.07

198.15

Boiling point

63.9° C

86.5 - 87° C

Specific gravity

1.417

1 .340

Flaminahilitv at room

temperature

non-flammable

borderline flammability

Odor

mildly ethereal

objectionable and penetrating

Table 3. Convulsive Thresholds (Inhala-
tion) of HFE and HFTE in Mice

Dose % Clonic % Tonic
Compound ml Convulsions Convulsions

HFE

0.15

0.20

0.25

0.30

0.50

100

0.65

100

0.80

100

1.20

100

HFTE

0.04

0.05

0.07

0.10

100

0.20

100

0.40

100

dried over magnesium sulfate and redistilled
through a 75 .x 1 cm column packed with
glass helices to yield pure bis (2,2,2-tri-
fluoroetiiyl ) thioether, 16 g.

Table 2 compares some of the physical
properties of HFE and HFTP'.

Measurcnicnts of tlu- convulsive thres-
hold of HFE and HFTE after inhala-
tion hy mice were made by the techni((ne
descrihed l)v Truitt ('/ <;/.'' for the all-or-
none response. Groups of ten mice were
used for each dose. (Iraded dose.s of the
convulsant were added to tlie j^auze all-
at-once ; the animal was allowed to re-
main in the jar for a ])eriod of ten min-
utes unless a tonic coiuulsion occurred
hrst. at which time the animal was re-
moved immediately.

A numlier of doses of HFE and

HFTE was administered to groups of
10 Webster mice each by intravenous in-
jection of a 1 /{ V/V solution in Carbo-
wax 300 (55%), alcohol (15%) and
water (30%). Some of the grotips were
pretreated with Tridione. 250 mg/kg,
intraperitoneally one hour before convul-
sant administration. Dose response lines
of the lethal and convulsive doses and the
LD5,, and CD50 and their 95% confidence
limits were established by the graphic
log-probit method of Litchfield and \\"\\-
coxon" from these data. The thera-
I^eutic index was calculated bv the ratio
LD.-,o/CD.-,„.

Two monkeys, 5 to 6 Kg, were ex-
])osed to the vapor of HFTE through a
t\])ical anesthesia inhalation mask. Vol-
umes of 0.2 ml were dispersed on gauze
in the mask.

Results

The ])harmacologic studies with
HFTE show that this compound, like its
oxygen analog HFE, is a potent convul-
sive agent in the mouse and monkey.

The data in Table 3 show the convul-
sive thresholds of HP'E and HFTE upon
inlialation in the mouse.

Figure 1 shows the restilts of HFE
injections into mice. The values are ex-
l)ressed as ml niouse. In the unpre-

July, 1Q64

BULLETIX OF THE SCHOOL OF MEDICIXE, UXirERSITV OF MARYLAND

99.99

99-1

5 90

' 70-

> 5CH
>

; 30
: 10

0.01

< ■ Convulsion

*— ^< Oeoth

O— "O Convulsion (+Tridione)

1^— « Death (+Tridione)

I 1 1 1 1 1 1

0005 0.010 0.020 0040 0.080 0.160 0320

DOSE HFE PER MOUSE IN ML

Fig. 1. Convulsive and lethal do.se response curves
for HFE after intravenous injection into mice.
The ordinate is a probit scale. The abscissa is ml
of a one per cent solution of HFE per mouse.

medicated animals the CD50 is 0.030 ±
0.005, the LD50 is 0.175 ± 0.039, and
the TI is 5.8. Tridione pretreatment did
offer some protection against the con-
vulsive effects of HFE hut not against
the lethal effects. The CD50 is 0.060 ±
0.010 while the LD50 remains the same.
Figure 2 shows the result of HFTE in-
jections into mice. In the unpremedicated
animals the CD50 is 0.013 ± 0.002, the
LDr.o is 0.020 ±1 0.002 and the TI is 1.5.
With Tridione pretreatment the CD50 is
0.032 :^ 0.005 while the LD.-,o remains
the same. Here again Tridione pretreat-
ment partially protected against the con-
vulsions but did not affect the toxicity.
Since the therapeutic index with pre-
treatment is less than one (TI=0.63),
it appears that at least part of the toxicity
is due to factors other than convulsive
properties. Of special interest was the
behavior of the mice exposed to HFTE.
After recovery from the convulsive seiz-
ure many of the animals exhibited a
peculiar activity of the muscles in the

9999

70
50
30

lOH

0.01

.^-.

Convulsion

X K

Death

1
1

0 0

®— ®

Convulsion
(t Tridione)
Deoth
(♦ Tridione)

/
J

a'
/
1

1 J
1 /
1 /

..-■■

■

/of/

/ I/O

0
/

0,4

..-■ /
1
/

/ ^^

0,C05 0.010 0.020 0040 0 080 0160
DOSE HFTE PER MOUSE IN ML

Fig. 2. Convulsive and lethal dose response curves
for HFTE after intravenous injection into mice.
The ordinate is a probit scale. The abscissa is ml
of a one per cent solution of HFTE per mouse.

neck and the head. The head was dropped
and moved upward rapidly for a period
of 5 to 10 minutes upon encountering
any form of stimulus. This phenomenon
endured for several days. This response
has never been observed following seiz-
ures evoked by HFE.

The two monkeys exposed to HFTE
vapors convulsed violently within 30
seconds of the vapor inhalation. The
tonic phase of the convulsion prevailed
for several minutes with marked opistho-
tonus followed by a clonic phase that
lasted for 5 to 8 minutes. It a]:)]ieared
that the response was more violent than
that evoked by HFE.

Summary

These studies show that bis (2.2.2-tri-
fluoroethyl) thioether, HFTE, evokes
convulsive seizures in mice and monkeys
similar to its oxygen analog. The thio-
ether is more potent as a convulsive
agent and also more toxic. From the data
on mice it appears tliat HFTE is twice

Vol. 49, No. 3

ROZMAN, ET AL.— ANESTHESIA LXJ'II: INDOKLON, A PSYCHIATRIC DRUG

as potent as its oxygen analog in evoking
convulsive seizures. The toxicity of
HFTE in mice is a])proxiniately 8 to 9
times that of HFE. Although the convul-
sive thresholds of HFTE may he raised
by Tridione pretreatment. toxicity is not
affected. These animal experiments in-
dicate the inadvisahility of using HFTE
in man to induce convulsive seizures in
the same manner in which HFE is
employed.

References

1. RoBBiNS, B. H. : Preliminary Studies of
Anesthesia Activity of Fluorinated Hydro-
carbons, J. Pharniacol. & E.vp. Thcrap., 86:197,
1946.

2. Lu, G. C, Ling, J. S. L. and Krantz,
J. C, Jr. : Anesthesia XLI. The Anesthetic

Properties of Certain Fluorinated Hydrocar-
bons and Ethers, Anesthesiology, 14:466, 1953.

3. Krantz, J. C, Jr., Truitt, E. B., Jr.,
Ling, A. S. C, and Speers, L. : Anesthesia LV.
Tiie Pharmacologic Response To He.xafluoro-
dietbyl Ether, /. Phanimcol. & Exp. Therap.,
121:362, 1957.

4. Convulsive Agent Passes FDA, Med.
ll'orld Nezvs,5: (#10) 172, 1964.

5. Oesteri.ing, R. E. : (Pennsalt.) U. S.
Patent 3,006,964, October 31, 1961.

6. Truitt, E. B., Jr., Ebersbkrger, E. AL,
and Ling, A. S. C. : Measurement Of Brain
Excitability By Use Of Hexafluorodiethyl
Etlicr (Indoklon). J. Phanimcol. & Exp.
Therap.. 129:4, 1960.

7. Litchfield, J. T., Jr. and Wilcoxon,
F. : A Simplified Method of Evaluating Dose-
effect E.xperiments, /. PJianiiaeol. & E.vp.
Therap.. 96:99, 1949.

ERRATA

\\'k wi-SII to make pul)lic apology to
Dr. Aaron Feder, Associate Professor
of Clinical Medicine, Cornell University
Medical School, for our failure to include
explanatory legends to the illustration,
diagram, and table in his article, "A
Quarter-Century of Mercurial Diuretic
Therapy," which was published on pages
59-62 of the October 1963 Bulletin
(Vol. XLVni No. 4).

Also in the footnote on page 59, we
listed Dr. Feder as Clinical Assistant
Professor of Medicine, Cornell Univer-
sity Medical Center, New York City, in-
stead of "Associate Professor of Clinical
Medicine, Cornell University Medical
School," and we failed to mention that
the article came from the "Department
of Medicine, Cornell University Medical
Center — New York Hospital." In.stead.
we mentioned only that the article was
presented at the annual Alumni Reimion,
I'niversity of Maryland .School of Medi-
cine, June 6, 196vS.

In the center of the lefthand column
of ])age 60, we reproduced a "Part of
l)age 146 of 'Course Outline' distributed
by the Department of Pharmacology,

University of Maryland, in 1935" with-
out appending this explanation in a
legend.

In the top of the lefthand column of
page 61, w-e reproduced the chemical
structure of "organic mercurial diuretic
compounds" without a heading and we
also failed to include a footline legend
stating that it was "Adapted from Pitts,
R.F., The Physiological Basis of Diuretic
Therapy, courtesy of author and Charles
C Thomas, Publisher. Springfield. Illi-
nois."

Also, we reproduced on the lower half
of page 61 a table without the title,
"Table I — Commonly Used Organic
Mercurial 1 )im'etic Com])ounds." Also,
this table should have carried a footline
legend stating that it was "Adai)ted from
Pitts. R.F., The Physiological Basis of
Diuretic Therapy, courtesy of author and
Charles C Thomas. Publisher, Sjiring-
field. Illiiii lis."

We are sorry that these omissions
occurred and apologize to all of our
readers as well as the autlior for the in-
convenience that these omissions may
have caused. — Kd.

July, 1964

Spinal Fluid Cytodiagiiosis of Central Nervous
System Malignancy*

(Preliminary Report) it

HOWARD M. WISOTZKEY, M.D. and RIVA NOVEY, M.D.

Since the introduction of exfoliative-
cell techniciue for the (hagnosis of uterine
cancer this method has heen widely em-
ployed in the detection of malignant cells
in such material as sputum, hronchial
washings, hody cavity fluids, and urine.
The value of cvtodiagnosis in malignant
tumors of the central nervous system has
not been widely recognized and has had
limited application. The finding that
certain tumors would desquamate cells
into the spinal fluid and by so doing make
the diagnosis possible was suggested and
demonstrated many times prior to the
development of a i)ractical technique
applicable clinically.

In 1937 Merritt and Fremont-Smith^
stated that tumor cells might l)e present
in the spinal fluid in cases of medullo-
blastoma, metastatic carcinoma, and sar-
coma. Others-' ^' •^' 5' ^ reported the des-
quamation and implantation of of gliomas
along the cranio-spinal axis. In 1951
Piatt described the normal cellular make-
u]) of ventricular, spinal, and cisternal
fluids and the morphology of neoplastic
cells in these fluids as well as in neo-
])lastic cysts. Following this there were
a number of reports of small groups of
cases in which the diagnosis of ma-

* This investigation was suiipurtcd in luirt by a
Public Health Service fellowship (5 Tl NB 5224 06)
from the National Institute of Neurologic Disease and
Blindness.

t This work is part of a continuing study. Since
this report was written 60 additional specimens have
been examined and will be reported at a later date.

t From the Division of Neuropathology, University
of Maryland School of Medicine, Baltimore, Md.

lignancv was made by the use of
cytologic methods applied to the spinal
tluid.'^- ''•'"• 11 More recently Kline ct
al.^- have reported the results of a study
of 2270 spinal fluid specimens. In this
series 110 patients were eventually
proven to have tumor, either at opera-
tion or at autopsy, and of this group 44
or 40 percent had cytologic studies posi-
tive for cancer. This figure is slightly
higher than what can be expected when
routine surgical and autopsy material is
surveyed for evidence of subarachnoid
extension of tumor. i^

In a pilot study one of us (R.N.)
examined a series of spinal fluid speci-
mens obtained from an unselected group
of 26 patients. Of these, five were shown
to have tumor and a diagnosis of oligo-
dendroglioma was made in one case. The
other four did not show subarachnoid
extension in subsequent pathological ma-
terial. These specimens were examined
by a centrifugation and smear techni(|ue,
no longer used.

Method

Spinal fiuid is obtained at the time
of lumbar puncture, from ventricular
aspiration or from neoplastic cysts. Since
the best methods of cytodiagnosis depend
on the examination of fresh material, the
fiuid should be prepared at the bedside
or at best to have the fluid arrive in the
laboratory as soon as possible. Many of
the cells will have been present in the
fluid for .some time and degenerative
changes will already have taken place.

Vol. 49, No. 3

IVISOTZKEY, NOVEY—SPINAL FLUID CYTODIAGNOSIS OF CNS MALIGNANCY

Any delay will further reduce the chances Table I

of having- an acceptable specimen. All .. , .

'^ / , • , , No. of patients 126

specmiens are to be processed with the

use of a 5 millimicron pore cellulose filter N°- ""^ <^^aminations 143

menil)rane.* The filtering process and No. of patients with proven tumor 22

staining procedure has been described No. of positive cytologic studies 6

elsewhere.'-^ % positive studies 27

Interpretation
Normal cells in the spinal fluid are Table II

usually single although some clumping

„ „ ' , 1 r . • "^ 1 No. of positive studies 6

can occur, infectious processes and con-

. 1 • 1 1 • r prmiarv tumors 2

ditions in which the protein content of metastatic tumors 4

the fluid is high may cause marked xt r • ,• / . ..

. " J\'o. of negative studies (tumor proven) 16

clumping. Clumps or groups must be primary tumors 11

differentiated from sheets of cells and in- metastatic tumors 5

terpreted with caution. Histiocytes and •

lymphocytes are easily identified. Arach- . ,.,,,_

. f , ,, , , . , 'ze glial cells. 1 wenty-six patients were

noidal cells are also i^resent but they , ^ , ,.,.,,

, ,.,-,. ,■ , , r 1 • ,• . shown to have tumor histologically and

may be dirterentiated from histiocytes • , , • • , . ,■ /^ , ,

, . , ,.^^ . . , ,, SIX had positive cytologic studies. (Table

only with ditriculty. A number of large -..^ . , ,..

, , , . , , ^ 1 ) In two patients the cytologic interpre-

cigar-shaped nuclei are also seen but are . . . . ^ ,

... . , -r 1 1 T. 1 111 tation was inconclusive and repeat exam-

not readily identifiable. It should be . . , , , . , „,

^ , , ,1^1 1-1 111 ination could not be earned out. Ihe

noted here that bare nuclei should be , ^ . , ,

, , , , ,. ,. . . number of primary and secondary tumors

excluded when making a diagnosis of . , • rr^ , , tt t- i

,. IS shown in lable Jl. f'our other patients
inali'^'nancy.

T-T** , ".' ,, , , , . , were discharged from the hospital with

Neoplastic cells from t)oth primary and ,..,,. . , .

, , , . , .^ , a clinical diagnosis of metastatic carci-

secondary neoplasms can be identified. , .7 , . . ,

^ ,, , ' ^. rr 1- 1 noma but without cytologic evidence or

Cells from metastatic tumors offer little , . , . .^ . '

,.£c 1^ .1 ■ 11 -1 histologic verification,

dirticulty as tfieir morphology is the same

as elsewhere. Primary tumors are more Discussion

difficult to identify. The criteria of ma- Qf the primary tumors of the central

lignancy must be stringently applied to nervous system, ependymomas, medullo-

avoid the possibility of false-positive re- l)]astomas and sarcomas, and sarcomas

])orts. In cyst fluids the cells may not might be expected to regularly exfoliate

have malignant criteria and this makes ^ells into the subarachnoid space. These

accurate diagnosis difiicult. tumors are not common and cells from

„ ,^ these are not always recoverable. Encap-
Itesults

_,,,,. , . , sulated tumors, such as meningiomas and

One hundred and forty-three spinal , 1 1 1 . .•

., . , . . i-,^' ■ 1 neurolemmomas, although at times in

tluid specimens from Izo patients have • , 1 , ,' ■ ,

, ,. , ^ , . ^ contact with the subaraclmoid space, can

been studied. 1 ouch preparations from , , r i- . 1 1

_,, , . , be expected to extoliate only capsular

50 central nervous system tumors stained ,, - • 1 • •

. , , -, . ,' . , , cells ol meningeal origin,

with the rapanicolaoii stains have also ^, , ^ . , .

, 1- 1 ■ 1 fhe largest group of primary brain

been studied m an atteini)t to character- / ,• , " n •

tumors, the gliomas, do not usually in-

^ — ■ \:u\c the subarachnoid space. Cytologic

* Cellulose filter memhrancs used were niamifac- . - i • • 11 i

tured by the Millipore Filter Corp., Bedf.ir.l, Mass. diagllOSlS Ot histologically beillgll tUIllOrS

July, 1964 41

BULLETIS OF THE SCHOOL OF MEDICINE. UNIVERSITY OF MARYLAND

is. therefore, a remote possil)ility except
following operation. This tyi)e of exami-
nation is snperflnons and is only rarely
carried out.

In pathologic material the majority of
metastatic tumors do not reach a surface
until late in the course of the disease.
Diagnosis hy cytologic methods is only
possihle when the meninges are seeded
primarily or when a metastatic lesion
hreaks into the subarachnoid space or
ventricular system.

The present series was obtained almost
entirely from patients admitted to the
neurosurgical service and attitudes and
practices of the neurosurgeon impress
themselves upon the study. When arterio-
graphic localization is possible in a pa-
tient with a clinical history suggestive
of tumor the patient usually goes to oper-
ation without having a lumbar puncture.
The reluctance of the surgeon to per-
form a lumbar puncture in the face
of elevated intracranial pressure even
though the clinical picture is not clear
accounts for some patients not having
cytologic examinations. Metastatic tu-
mors are not common on this service and
the lack of interest manifested by other
hospital services limits the contact with
these tumors.

Where does the cytologic examination
of the spinal fluid fit into the problem
of the diagnosis of central nervous sys-
tem neoplasia? In those patients where
the clinical situation makes luml)ar punc-
ture inadvisable the likelihood of making
a positive diagnosis would not seem to
be worth the risk. However, in patients
where the clinical diagnosis of a mass
lesion is established and immediate oi)er-
ation is not mandatory, cytologic studies
may differentiate primary and metastatic
tumors. In those patients in whom the
clinical diagnosis is in doubt, spinal fluid
examination by this method may yield

valuable information. /\n unexplained
pleocytosis in a routine spinal fluid exam-
ination should be an indication for cyto-
logic studies.

This is graphically illustrated by the
following case.

Cliniciil History: A 25-year-old male was
aclniitted to the hospital because of severe
headaches and neck pain of 1 month's dura-
tion. He had had transient episodes of diplopia
and "black-out" spells. Six days prior to
admission he was examined by a neurologist
at another hospital. At that time he had
bilateral papilledema, palpebral sagging on the
right side, and deviation of the uvula to the
left on phonation. The deep tendon reflexes
were slightly more active on the right. An
electroencephalogram revealed bilateral delta
wave activity with some left sided preponder-
ance. On admission to the University Hospital
the neurologic examination was similar to that
previously recorded. In addition, a right sixth
nerve weakness and a left extensor toe sign
had developed. Bilateral carotid arteriography
and ventriculography were not diagnostic. The
ventricular fluid was xanthochromic and the
white cell count was 774, all of which were
interpreted as lymphocytes. Repeat arteriogra-
phy was interpreted as normal. The patient
expired on the 23rd hospital day.

Cytologic examination of the ventricular
fluid revealed multiple clumps and sheets of
small neoplastic cells. Two repeat studies con-
firmed the findings. The cells were thought
to be from an ependymoma but autopsy re-
vealed a circumscribed arachnoidal sarcoma
arising from the anteriolateral edge of the left
cerebellar hemisphere. In this case the presence
of a neoplastic process was detected, although
its cellular type was not properly identified.
Retrospective study of the diagnostic X-rays
fail to reveal any clue to the presence of a
tumor.

Summary

The cytologic study of the spinal fluid
in cases of suspected primary or secon-
dary tumors of the central nervous sys-
tem has a definite place as a diagnostic
aid. It cannot be expected to ])roduce
diagnostic results in those tumors lying
deep in the brain substance. Those tu-
mors which come into contact with the

Vol. 49, No. 3

WISOTZKEY, NOV EY— SPINAL FLUID CYTODIAGNOSIS OF CNS MALIGNANCY

spinal fluid will yield recoverable cells.
When used in conjunction with the al-
ready available diagnostic methods this
technique may be of jxarticular value in
separating primary from metastatic neo-
plasms or in making a diagnosis where
other methods have failed or have been
inconclusive. It should be emphasized
that the method is not a substitute for
histologic conflrmation by biopsy. An
illustrative case is presented.

References

1. Merritt, H. and Fremont-Smitu, F. :
The Cerebrospinal Fluid. W. B. Saunders Co.,
Phila. and London, 1937.

2. Foster, E. : Die Bedeutung des Liquorzel-
libildes fur die Diagnostik der Tumoren des
Zentralnervensystems and die vom Plexus und
den Aleningen Ausgehenden Tumoren. Zfschr.
Ges. Neurol, u. Psych. 126: 683-720, 1930.

3. CusHiNG, H. : E.xperiences with the Cere-
bellar Medulloblastomas : .\ Critical Review.
Acta Path, ct Microbiol. iScaudiuaz:) 7: 1-86,
1930.

4. Cairns, H. and Russell, D. S. : Intra-
cranial and Spinal Metastases in Gliomas of
the Brain. Brain 54: 377-420, 1931.

5. PoLMETEER, F. E. and Kernohan, J. W. :
Meningeal Gliomatosis : .\ Study of 42 Cases.
Arch. Neurol, and Psychiaf. 57: 593-616, 1947.

6. Svein, H. J., Gates, E. M. and Kerno-

han, J. W. : Spinal .Subarachnoid Implanata-
tion Associated with Ependymoma. Arch.
Neurol & Psychiat. 62: 847-856, 1949.

7. Pl.-vtt, W. R. : Exfoliative Cell Diagnosis
of Central Nervous Lesions. Arch. Neurol, and
Psychiat. 66: 119-144, 1951.

8. McCormack, L. J., et al. : Identification
of Neoplastic Cells in Cerebrospinal Fluid by
a Wet-film Method. Cancer 10: 1293-1299,
1957.

9. Spriggs, a. I.: Malignant Cells in Cere-
brospinal Fluid. /. Clin. Path. 7: 122-130, 1954.

10. McMenemey, W. H. and Cumings, J.
N. : The Value of the Examination of the
Cerebrospinal Fluid in the Diagnosis of Intra-
cranial Tumors. /. Clin. Path. 12: 400-411,
1959.

11. Marks, V. and Marrack, D. : Tumor
Cells in the Cerebrospinal Fluid, /. Neurol.
Neurosurg. and Psychiat. 23: 194-201, 1960.

12. Kline, T. S. et al. : Tumor Cells in the
Cerebrospinal Fluid. /. N eurosurg. 19: 679-
684, 1962.

13. Wagner, J. A. et al. : Subarachnoid
Neoplasia : Incidence and Problems of Diag-
nosis. South Med. J. 53: 1503-1508, 1960.

Acknowledgements

The authors wish to thank Dr. Zuher ^{.
Naib and Dr. M. Wilson Toll for their help,
encouragement, and advice. The technical
assistance of Airs. Geneva G. Lord and many
others was invaluable. The full cooperation of
the Department of Neurosurgery is also grate-
fully acknowledged.

Julx. 1964

Give to the
school of your choice
through AMEF

American Medical Education Foundation

To train the doctors of tomorrow,
the nation's medical schools must have
your help today. It is a physician's unique
privilege and responsibility to replenish
his own ranks with men educated
to the highest possible standards.
Invest in the future health of the nation ani
your profession. Send your check today!

535 North Dearborn Street
Chicago 10, Illinois

MEDICAL SCHOOL SECTION

Pear Members of fJie Alumni and Friends oj
the Medieal Seliool:

During the school year 1963-64 the Faculty
Curriculum and Instruction Committee has con-
tinued to study our educational program for the
medical student. These studies have resulted in
some modification and adjustment of the teaching
hy individual departments. However, the most im-
portant recommendation of the Committee, which
has heen adopted hy the Faculty Board for 1964-
65, is an increase in free time for the student to
select areas of study centered on the student's
interest. This changes the medical education pro-
gram from a lock step faculty dictated program to
a program of hasic medical education enriched hy
areas in which the student has special interests in
depth.

A real measure of the maturity of our students
will l)e ohtained by ohjecti\e evaluations of how
well the students use their free time to develop
themselves into outstanding physicians. The stu-
dents are tluis being clKillenged to demonstrate
their abilitv and resourcefulness for careers in

meclicine.

Sincerely,

\\'jLLi.\M S. Stone. ^I.D.
Dean

July. 1064

Prc-coiiiinenceinent and Dean's Day
Celebrated June 2

I.N HONOR ot the graduatiiijj^ Class of
1%4, the customary annual Dean's Day
and ])re-coninicncenient exercises were
celehrated on the campus heginning witli
ail academic jirocession at 1 :30 p.m.

Following the invocation by the Rev-
(Mtnd Donald C. Kerr. Pastor of Roland
l';irk Tresbyterian Church. Dr. R. Lee
Ilornheck. \'ice-President of the Uni-
\ ersity of Maryland for academic affairs,
extended greetings to the graduating
class. Prizes and honors were then
awarded by Dr. William S. Stone. Dean
of the School of Medicine. This was fol-
lowed bv the customary Hipjiocratic
Oath.

Dr. Paul Sanazaro, Principal Speaker

I'rior to the presentation of the awards.
I )r. Paul Sanazaro. Director of the Divi-
sion of I'2ducation of the Association of
.\nierican Medical Colleges, spoke on the
subject, "Revolution and Renewal in
Medicine." The complete text of Dr.
Sanazaro's article is published elsewhere

in (he lifLLKTIX.

Honors and prizes were as fcjllows :
Faculty Gold Medal (Sum ma Cum Laudc) — ■

ClIAKLES He.VRV Asi'LKN

Certificate of Honor (Magna Cum Laudc) —
KiiHAUD DoL'Gi,.iiS Biggs, Jk.

Certificates of Honor (Cutii Laudc) — Don-
ald Theodokk Lewers, Miltox Siegfried
MicuAELis, Charles Evans Reikson.
Marvin Frederuk Saioxtz, and IIakoii)
Clark Standii-ord

I .alder Scholarshi]) Award for liigliest de-
gree of academic acliievenient — Charles
Henry Aspi.ex

Dr. Leonard M. Hummel Medal for excel-
lence in Internal Medicine — Donald The-
odore Lewers

Dr. Harry M. Kol)in.son, .Sr. I'rize for ex-
cellence in Dermatology — Marvin 1'red-
ERicK Saiontz

Dr. Wayne W. Bahcock Award for excel-
lence in Surgery — Jonatha.x David

TlERK

Dr. A. P.radky ( iaitlicr I'rize for excellence
in genito-urinary surgery — Charles Evans
Reckson

Medical Book .Award for outstanding scho-
lastic attainment — .Sir art Ha.xdwerger,
Kith Flizareth Luddv. and Robert
Elmer Stoner

Student Council Keys — Rich.^rd John
Kkm.v, John Manfred Ratino

Student Council Certificates — Henry Hu-
bert Bowman. William Green Cusher,
Richard John Kelly, Albert Bernard
Fleet, John Manfred Rating, Marvin
Frederick .Saiontz, Eric Dean Smitter

Following the exercises, tea was served
in Howard Hall, with wives of the med-
ical students acting as ushers and host-
esses.

Commencement

On Satiuxlay. June 6. at commence-
ment exercises held at College Park, de-
grees of Doctor of Medicine were con-
ferred by Dean Stone on the members
of the Class of 1964. These newly cre-
ated Doctors of Medicine then departed
for vacations prior to l)eginning the
practice of medicine through their intern-
ships.

Internships — Class of 1964

-Vmitin, Sig.mind a.

South Baltimore Gcucral Hospital. Balti-
more, Md.

.Ashman. Michael N.

Jc-a'ish Hospital. Brooklyn 3S. N. Y.

AsilMAX, PllH.Il' AI.

I larrisburcj Hospital. Harrisbunj. Pa.
-Asple.x. Charles H.

University Hospital. Baltimore L Md.
Baker, Lynn B.

University Hospital, luillimore 1. Md.
Becker, Lario'

.S'/;;<;/ Hospital. Baltimore L''. Md.
Belinic, Moxa B. S.

Mercy Hospital. Baltimore 2. Md.
Bigbee, Thomas P.

S(nitli Baltimore Ceneral Hospital. Balti-
more. .\hl.

Vol. 49, No. 3

MEDICAL SCHOOL SECTION

Biggs, Richard D., Jr.

University Hospital. Bui ti more 1, Md.

BOHLMAN, HeNRV I{.

Unii'crsity Hospital. Baltimore /, Md.

Bkaukk, Kim a L. R.

Moiitefiore Hospital. Ne^a' York 67, N. Y.

Byers, William S.

Mercy Hospital, Baltimore 2. Md.
Cohen, Barry M.

Sinai Hospital. Baltimore L^. Md.
Cohen. Miriam L.

Hanuwerger, Stuart

Bronx Municipal Hospital Center A^, Nezv

York 61. N. Y.
Hartman, Ira F.

University Hospital, Baltimore 1, Md.
Hazard, Robert G.

Providence Llospital. JJ'ashingfon 22, D. C.
Hiley, Paul C.

U. S. Public Health Serx'icc
Jones, Euclid H.

U. S. Public Health Seri'ice

Union Memorial Hospital. Baltimore 18, Md. Kaplan, Rosalind B. P.

Colon, (iusTA\(i A. Jl'ashington Hospital, Washington, D. C

U. S. Public Health Service Katzen, Leeds E.

Conroy, John I. Mercy Hospital, Baltimore 2, Md.

Church Home and Hospital, Baltimore 31, Kaufman, Matthew L.

-1/^. Ilarrisburg Hospital. Ifarrisburg, Pa.

CuLOTTA, Dominic A. Kelly, Richard J.

Uniz'ersity Hospital, Baltimore 1, Md.

CusHARD, William G., Jr.

Charity Hospital of A'ezc Orleans, Nezv

Orleans 40, La.
Dagon, Ann B.

Union Memorial Hospital. Baltimore 18, Md.
Dayton, David A.

George F. Gcisinger Hospital, Danznlle, Pa.
De Beck, Thomas W.

Unizrrsity Hospital, Baltimore 1, Md.
Dear, William A., Jr.

St. Agnes Hospital, Baltimore 29, Md.
Deinlein, Donald A.

Mercy Hospital, Baltimore 2, Md.
Detorie, Frank M.

St. Agnes Hospital. Baltimore 29, Md.
Donohue, Salvatore R.

Mercy Hospital, Baltimore 2, Md.
Doyle, Robert L.

Mercy Hospital, Baltimore 2, Md.
Francis, Earlie H.

South Baltimore General Hospital, Balti-
more, .Md.
Gin CELL, Robert L.

University Hospital, Baltimore 1, Md.
Glass, Simon D.

Army Medical Serz'ice Hospital, Ji'illiam

Beaumont General
Goldstein, Marvi.n X.

Uniz-ersity of Chicago Clinics, Chicago 37,

III.
Gordon, Albert M.

University Hospital, Baltimore 1 , Md.
Gresser, Lee E.

Sinai Hospital, Baltimore 15, Md.

St. Agnes Hospital, Baltimore 29, Md.
Kilchenstein, AIichael

Johns Hopkins Hospital, Baltimore 5, Md.
Kirchenbauer, Stanley

South Baltimore General Hospital, Balti-
more, Md.
Krugman, Mark E.

Mount Sinai Hospital, Nezv York 29, N. Y.
Lee, Charles D., Jr.

Passavant Memorial Hospital, Chicago 11,

III.
Lewers, Donald T.

Uniz'crsity Hospital, Baltimore 1, Md.
Lindenstruth, Danik.i.

University Hospital. Baltimore 1. Md.
Luddy, Ruth E.

University Hospital. Baltimore 1. Md.
LuTz, John H.

Church Home and Hospital, Baltimore 31,

Md.
McGiNLEY, Edgar V.

South Baltimore General Hospital. Balti-
more, Md.
MicHAELis, Milton

San Francisco Hospital, San Francisco 10,

Calif.
Mindel, Joel S.

University Hospital. Ann .Irbor, Mich.
Muher, Samuei,

Sitiai Hospital. Baltimore 15, Md.
Xagel, Jacob D.

Mercy Hospital, Baltimore 2, Md.
Nichols, David M., Jr.

Mercy Hospital, Baltimore 2, Md.
Pleet, Albert B.

Uniz'crsity Hospital, Baltimore 1, Md.

July, 1964

BVLLETIX or THE SCHOOL OF MEDICINE. rXirERSri'V OF M.IRVL.IXD

Porter, Thomas J.

U. S. Public Health Service
QfixoNKS, Jose D.

V. S. Public Health Service
Rati. no. John M.

South Paltiinore Ceneral Hos(>ital. Balti-

viore. Mil.
Reikson, Charles K.

University IIosf>ital. Paltiinore 1. Md.

Reich MISTER, Jerome I*.

Sinai Hospital, Baltimore 15. Md.
Robbins, E. Lee

Mercy Hospital. Baltimore 2. Md.
RosEXBAiM, Barry N.

University Hospital, Baltimore 1. Md.
RuLEY, Edward J.

University Hospital, Baltimore 1, Md.
Saioxtz, Marvin F.

Sinai Hospital, Baltimore 15, Md.
ScHMiTTER, Eric D.

San Francisco Hospital, San Fra)icisc(>. Calif.
Schwartz, Allen D.

Grace i\'ci>.' Haven Hospital, New Haven 4,

Conn.
Schwartz, William E.

Mercy Hospital, Baltimore 2, Md.
Seidman, Sidney B.

Sinai Hospital, Baltimore 15, Md.
Shelton, Perry S.

Mercy Hospital. Baltimore 2. Md.
Shugarmax, Richard G.

Sinai Hospital, Baltimore 15, Md.
Solomon, Lawrence F.

Sinai Hospital, Baltimore 15, Md.
Spector, Gershon

Beth Israel Hospital. Boston 15, Mass.
Standiford, Harold C.

University Hospital. Baltimore 1. Md.
Stoner, Robert E.

Uniz-ersity Hospital. Baltimore 1, Md.
Tlerk, Jonathan D.

University Hospital. Baltimore 1. Md.
Weagly, John K.

South Baltimore Cicneral Hospital. Balti-
more, Md.
Weir, Walter D.

South Baltimore General Hospital. Balti-
more, Md.
Wilson, Sherwood E.

South Baltimore General Hospital. Balti-
more, Md.
Yalam, Arnold R.

Jackson Memorial Hospital. Miami 36. Fla.
Young, Marston A.

St. Agnes Hospital, Baltimore 29. Md.

School of Medicine Affiliated
with Eye Research Foundation

An affiliation between the I'niver-
sity of Maryland School of Medicine and
the Eye Research Foundation. Bethesda,
Md., was recently announced jointly by
Dr. William S. Stone. Uean of the Scliool
of Medicine, and Percy J. Trevethan,
President of the foundation.

Under the terms of the affiliation or-
ganized chiefly for the purpose of teach-
ing and research, the Medical School's
Department of Ophthalmology, headed
by Dr. Richard D. Richards, will work
closely with the foundation. Ophthalmol-
ogy residents will l)e sent to the founda-
tion for training in basic and clinical re-
search problems and senior investigators
at the foundation will be eligible for fac-
ulty appointments in the Medical School.

Dr. Richards has been named a mem-
ber of the Scientific Council of the Eye
Research Foundation and Dean Stone, a
member of its Advisory Board.

The Eye Research Foundation is a
nonprofit organization set up under a
trust fund some six years ago for pioneer-
ing studies of such conditions as mini-
mal vision cataract, glaucoma, and can-
cer of the eye. It now occupies a new
$600,000 building near the National In-
stitutes of Health in Bethesda. Dr.
William M. Hart is director of the foun-
dation, which is supported by private
donations and grants-in-aid of research.

Campus Computer Center To Be
Developed at School of Medicine

The School of Medicine has recent-
ly been awarded a grant from the Na-
tional Institutes of Health to support the
establishment of a Health Sciences Com-
])uter Center on the Baltimore campus.

The grant, totaling $296,883. will help
supi)ort the center over a 27-month
period.

The computer, which will be located

Vol. 49, No. 3

MEDICAL SCHOOL SECTION

on the first floor of Howard Hall, is
scheduled to hegin operation in the fall
of 1964. Equipment, designed particu-
larly for health problems, will include an
IBM 1620 digital computer with an IBM
analog to the digital system. The center
will also include other supporting equip-
ment.

The instrument installed on the P)alti-
more campus will ser\-e as a branch of
the Computer Science Center at College
Park, with comjilete compatability of all
computer ecfuipment. A courier service
will be estal)lislied. serving to facilitate
the transmission of magnetic tape and
IBM cards to and from the main Com-
puter Center at College Park.

According to Dr. George Entwistle,
the facilities will l)e available on an inter-
departmental basis. Already plans are
underway for complex analyses of data
obtained in the air pollution studies
under the direction of the Department
of Medicine.

Based on an analysis of a large group
of patients, the Department of Radiology
proposes to use the instrument as a means
of calculating appropriate doses of radi-
ation at dift'erent depths for different
types of tumors. In Psychiatry, projected
use of the apparatus will relate to a cor-
relation of complex data relating to ver-
bal behavior. It is anticipated that the
instrument will l)e of great assistance in
the many complex analytic problems re-
lating to research in Medicine and allied
fields.

Dr. Spicer Receives Additional Air
Pollution Grant

Dr. \VILLIA^[ S. Spicer, Jr., head of
the Division of Pulmonary Diseases, has
received a supplementary award of near-
ly $200,000 from the U. S. Public Health
Service to support a continuation of his
studies of the relationship between air
l)ollution and pulmonary diseases. Dr.
Spicer. whose pre\ious investigation has
shown a relationship l)etween air pollu-
tion and lung disease, will now expand
his program to include the effects of
smoking as well as air ])ollution on lung
diseases.

Dr. Storey to Head A.M.A.
Postgraduate Program

The American Medical Associa-
Tiox has announced the appointment of
Dr. Patrick B. Storey, former faculty
member at the School of Medicine, as
Director of the A.M.A. Department of
Postgraduate Programs. Dr. Storey, who
has headed the School of Medicine's
postgraduate program since 1960, will
head the A.M.A. program designed to
place before the 271,000 physicians of the
country a realistic program of continu-
ing medical education.

Known until recently as the Depart-
ment of Scientific Assembly, the depart-
ment in the past has been primarily con-
cerned with organizing the scientific pro-
grams at the annual A.M.A. meetings.

Jul\. 1Q64

faculty

NOTES

Dk. 1"'i"1ir.\im T. LisAXSKY, Associate
Professor of ^Medicine and Clinical Psy-
chiatrv at the School of Medicine, has
recently heen director of a course entitled,
"Psychiatry for the Internist," a five-day
l)ostgradiiate course approved under the
auspices of the American College of
Physicians and held at the School of
^Medicine June 15 to 19. Other faculty
participants in the course included Dr.
Russell R. Monroe, Professor of Psy-
chiatry ; Dr. Eugene B. Parody, Profes-
sor of Psychiatry and director of The
Psychiatric Institute; Dr. A. Russell
Anderson, director of the Baltimore
Psychoanalytic Institute and Associate
Clinical Professor of Psvchiatry ; Dr.
Samuel P. Asper, Jr., of Johns Hopkins
I'niversity : Dr. Leo H. Bartemeier, med-
ical director of the Seton Psychiatric In-
stitute and Clinical Professor of Psychi-
atry at the School of Medicine ; Dr. \\\\-
liam S. Stone, Dean ; and Dr. Theodore
E. Woodward, Professor of Medicine.

Dr. Lawrence Earl H inkle, Professor
of Clinical ^Medicine at Cornell Llniver-
sity Medical College, spoke on the rela-
tionship between social and psychological
stress and such illnesses as i)eptic ulcer
and coronary thrombosis. His specific
topic was "lluman Ecology in the Oc-
currence of Disease."

Dr. Samuel P. Bessman, Professor
of Pediatrics Research, participated in a
Congress on Mother and Child Health
in Warsaw, Poland, June 22 to 28. Dr.
Bessman delivered a lecture entitled,
"The Role of Ammonia in Normal Me-
tabolism and Disease."

Dr. Vernon B. Krahl, Professor of
Anatomy, ])resented the opening paper

at the Third luu'opean Conference on
-Mircocirculation held in Jerusalem, Is-
rael, March 15 to ]''. 1^)64. Dr. Krahl's
])aper on pu]inonar\- microcirculation in
the frog was written in collaboration with
Dr. Hollis G. Boren, director of the ])ul-
nionar\' research laboratories of the Trvi-
deau r^oundation, Saranac Lake, N. Y.
Dr. Krahl received a National Insti-
tutes of Health research career award in
1962, one of several granted in nation-
wide competition to investigators of
])roved ability in independent research
and teaching.

Promotions Announced

Dr. Theodore Leveque of the Depart-
ment of Anatomy has been recentlv pro-
moted to Professor of iVnatomv in the
School of Medicine.

In the Department of Pathologv, Drs.
Peter Rasmussen, Wilson Tall, and
Charles S. Petty (Forensic Pathology)
have been promoted to the rank of Asso-
ciate Professors.

In the Department of Preventive Med-
icine, Dr. Maureen M. Henderson has
been promoted to the rank of Associate
Professor.

In the Department of Psychiatry, Dr.
Isadore Tuerk has been elevated to
Assistant Clinical Professor of Psychi-
atry.

Dr. Thomas C. Flotte of the Depart-
ment of Surgery has also been named
Associate Professor of Surgery.

New a])])ointments include Dr. Harley
V. Barrett as Associate Professor of
Preventive Medicine and Rehabilitation.

Faculty Members Contribute to
New Cecil's Textbook of Medicine

Drs. Fred R. McCrumb, Jr. and
Theodore E. Woodward are among the
173 contributors to the 11th edition of
the Cecil-Loeb Textbook of Medicine.

Vol. 49, No. 3

Revolution and Renewal in Medicine

PAUL J. SANAZARO, M.D.

The L'xivERSiTV of Maryland
School of AIedicink is an old school
by American standards, having been or-
ganized in ISO". I'^ven though cjuite
young when measured against 5,000 years
of medical history, your school shares
in full the spirit of rich heritage which
is uni(|ue to medicine. Over the years,
its many imiovations have kept the
school at the forefront of medical educa-
tion. And, like all veneraljle institutions.
]\Iaryland has recorded its ])roud his-
tory, giving us a unique glim])se into its
past. A sketch of student days l)y a grad-
uate of the class of 1830 strikes familiar
notes: "I had to sit constantly for eight
hours every day during four months on
a hard l)ench attending medical lectures.
I would not undertake the task again
with similar health for any honor or
emolument that I could derive from it.
It left me unable to move." Certainly a
graphic description of a state keenly
remembered l)y all medical students.
Even though lectures no longer last for
eight hours, they occasionally seem to.
In describing his final examination the
articulate graduate of 1830 speaks for
you today: "I passed my examination
on the fifth of ]\Iarch. It was a most try-
ing ordeal. My character was involved
and with it my peace, for you know my
pride could not well endure a rejectioiL"
Finally, he described this ritual in which
medicine is annually replenished : "Then
a month later came the commencement
with its triumphs ... I received my di-
ploma in com])anv with the other 50

Director, Division of Education, Association of
American Medical Colleges, 2530 Ridge Avenue,
Evanston. Illinois.

graduates on the fifth of Ai)ril. They
were handed to us by the Provost in the
anatomical theater of the University in
the ])resence of the most beautiful and
fashionable assembly of ladies and gentle-
man I ever saw. In the meantime, the
city band jjlayed the most delightful airs.
A professor of materia uicdica delivered
a valedictory oration in which he gave
many useful hints to the graduates on die
course it was now necessary for them to
pursue in order to succeed in their
career." Every class of graduating stu-
dents must experience this same mixture
of euphoria, release, and resignation to
the exhortatory address.

Your education, received at the same
school as our spokesman for the past.
has been far different, for medical edu-
cation and the University have shared
both the continuing revolution and re-
newal that are the hallmarks of medicine.
The Oath of Hippocrates defines that
])oint in medical history where revolu-
tion and renewal were first inseparal)ly
linked, for the Hippocratic school sup-
])lanted mvsticism with reason and rit-
ual with the forerunner of the experi-
mental method. Hippocratic medicine
was holistic, considering illness as insep-
al)le from the patient's distress. Physi-
cians did not then concentrate on "the
disease" l)ecause the concept of disease
as an entity lay 20 centuries in the future.
It is one of the quirks of history that a
contemporary of Hippocrates — Democri-
tus — should be the first to suggest that
all matter might be composed of indi-
visible particles which he called "atoms"
and that ultimately all substances — in-
cluding people — might be analysed in
terms of their constituent atoms. This

Julv. 1064

in'i.i.ETis Of Tin- SCHOOL of medicine. UNicEKsrry oi- makvl.ixd

philosophical concept foresaw the day
when the symptoms and signs which
Hippocrates so carefully ohserved and
recorded would be analysed on a molecu-
lar, even atomic, basis. Today, atoms and
portions of atoms, as electrolytes, iso-
topes and radiation, are essential in the
study, diagnosis, and treatment of dis-
ease. This is the incredible revolution
in medical science, encompassing 23
centuries, transforming descriptive, em-
pirical, holistic medicine into human
biology. Throughout the uneven course.
it has ever been the renewal of the Hip-
pocratic ethic that has preserved for you
the opportunity }'oii now have earned
to serve and contribute as an appropri-
ately educated physician, rather than as
a technician or an entrepreneur.

The responsibility placed on today's
medical schools is unusually demanding.
It has required the resources, standards,
and ideals of the University to prepare
you to use the best lessons of the past, to
be discriminating in your choice of future
lessons, to continue to grow in knowledge
and skill, to contribute to medical science
— all of this so that you may serve so-
ciety fully and wisely. Tt can be argued
without too much violence to fact that
medicine today is the final common path-
way of all historical revolutions (includ-
ing the scientific, industrial, technologic,
social, and religious) that have shaped
man's relation to man and to society over
the past five centuries. Their cumulative
effects are uniquely focused u]:)on the
very personal encounter between patient
and physician. It has been the continu-
ing renewal of basic ethical principles by
each generation of physicians, rather
than the advance of science or rise in
social standards, that has preserved med-
icine as a true profession in the fullest
sense of the word. An earlier form of
the Hippocratic Oath thrm that to which

you have subscribed epitomizes this

renewal :

I will follow that svstcm of regimen
which, according to ni\' al)ilitv and
judgment. 1 consider for the benefit of
my i)atients. and abstain from what-
ever is deleterious or mischievous.

Xote the cardinal principles of a pro-
fessional commitment: regimen is to be
based on the individual physician's abil-
ity and judgment, not on adherence to
fixed rules. The intended result is the
benefit of patients. There is specific dis-
a\-owal of all measures that are in them-
selves injurious or "mischievous."

What of the ])hysician's "ability" to-
day, compared with that of Hippocrates ?
\o\\ have at hand the weapons for pre-
venting diseases that once decimated
nations. You can now cure or control
disease or suffering by a telephoned
prescription. Science has taken Hippoc-
rates' concept of the humors and provid-
ed you \\'\i\\ potent hormones and drugs
to control and modify basic body mech-
anisms. Surgery has moved from a me-
chanical to a physiological base, enabling
it to deal with hereditary or acquired
conditions in almost every organ system.
This era of molecidar biology has made
a reality of the ancient dream of organ
transplantation. And it is taken for
granted that ])ills are available to all at
the corner drug store that with delightful
p»recision eliminate onlv procreation from
all other functions of the most basic
human interaction.

All this indicates that the ])hysician
has changed his role in the struggle
against death, disease and undesired con-
sefjuences. He is no longer limited to
comforting the ill ; he is an active inter-
vener possessing a vast array of effective
biochemical and physical tools. These in
turn are the ])ractical result of applying
the scientific method to the studv of

Vol. 49, N.o. 3

MEDICAL SCHOOL SECTION

luniian disease by considering the body
as a machine, or at least an analysable
liiological coni])lex. Without for the mo-
ment deltating whether man is or is not
a machine, it is historical fact that this
assumption, and research based on this
assumption, lias given medicine a hrm
and enduring scientific l)ase. And it is
this which endows you as physician with
therapeutic ])otency l)eyond the visions of
even the most visionarv of ])ast genera-
tions.

])Ut these exciting ad\ances at the
same time raise perplexing ethical cjues-
tions. Medical ethics are not simply ac-
ceptable business practices. The profes-
sional ethics of medicine are rooted in
basic morality because the physician is
entrusted by society to deal with human
problems and human life in a manner
permitted no other individual by law or
tradition. An abiding sense of ethics
cannot be acquired as readily as knowl-
edge of the latest concept of DNA cod-
ing, and although morality in its funda-
mental sense does not change over time,
the combination of social evolution and
continued scientific advances creates new
situations requiring fresh ethical inter-
pretation. Knowing the concern of the
University of Maryland that its gradu-
ates should be prepared both to advance
knowledge and to u])hold the heritage of
medicine, you have alreadv had oppor-
tunity to begin your lifelong task of
exploring the ethical challenges to your
generation.

Consider some examples. Research in
medicine today requires human experi-
mentation. Ideally, human experimenta-
tion should only proceed with the full
and informed consent of the patient. Hut
although this is the position demanded
by fintdamental moral values, a number
of ])ractic<'d and legal considerations have
kept the medical ])rofession and the re-
search communitv from irencrallv endors-

ing such a code. I>ut if full and informed
consent is not mandatory for all experi-
ments on patients, what is the appropriate
comjjromise? W'hich are to be the guid-
ing ])rinci])les ? The controversy may be
illuminated by asking, is it for the benefit
of medical scioicc or for the benefit of
the j^a/icnt that our ability and judgment
are to l)e used in conducting human
experimentation ?

The enticing nearness of further
breakthroughs makes it seem to some a
small and reasonable price that not all
])atients know in full what is required
of them or what the immediate or de-
layed consequences might be. For exam-
ple, greater applicability of organ trans-
p.lantation awaits more effective means
of inducing tolerance by suppression of
the immune mechanism. All of us can
enumerate the potential blessings of
eliminating cumbersome medical proce-
dures for dealing with end-stage organ
damage and instead restoring function by
organ replacement or organ augmenta-
tion. To watch a sickly child who has
never known a single day of comfort or
well-lieing be transformed bv an organ
transplant into an exulting l)oy who now
runs and pla}-s can only make us impa-
tient with the slowness of progress. But
what are the long-term consequences of
suppressing such a fundamental svstem
as the immune mechanism in a voung
person ? How can one, on ethical grounds,
proceed with the large scale human ex-
])erimeiitati()n needed to satisfv the re-
(|uirements of the e.xperimental method,
yet adef|uately inform the ])atient or his
]iarents of the ])()tt'ntial consequences,
many of which are largely unknown? Is
it the ])rerogative of the ])hysician-scien-
tist to make these judgments for the
])atient? How will you projjose to resolve
this means-and-ends dilemma ?

There are less dramatic but no less
complex situations in which the physician

Julv. 1964

HVU.ETIX OP TIIF. SCHOOL OI- MliDICIXH. rMll-h'SITV OF MARYI.AXD

can pcnnaiK'ntly niodil'v basic i)hysi()l()!Liic
functions. This enormous and steadily
increasing potency must be directed by
a continuing and growing sense of ])er-
sonal moral resi)onsibility for the liunian
conse(|uences. For e.\am])le. \nur gen-
eration may well be the lirst to manipu-
late or attempt to niani])ulate the genetic
components in living man. What consid-
erations will enter into your first such
experiment on a human being? \\ ill they
be primarily scientillc, or ])riniarily eth-
ical?

To jiaraphrase John (Gardner , knowl-
edge is a safe weapon only if it is linked
to a deeply rooted conviction that medi-
cine is for the benefit of men and not
men for the benefit of medicine. The re-
search scholar has the inviolate freedom
of the academic community to advance
knowledge for the sake of knowledge.
However, what can be done in research
on man does not in itself justify its being
done on man. I'nlike the challenge to the
mountain climber, an un.solved problem
in n:an is not to be studied just "l)ecause
it is there." The answers to i^'licthcr an
ex]:)eriment should be done and hoic it
should be done always derive from eth-
ical ])rinciples. This is the continual re-
newal to which you as i)h\sicians are
called.

There are other aspects of medicine
which require ethical analysis. As physi-
cians, each of you will ])rolong the pro-
ductive lives of yoiu" ])atients. Xot only
that, you will make possible their enjoy-
ment of life beyond the time when thev
no longer need to be economically self
sufficient. (This achievement is perhaps
less a tribute to medical science than it
is to the industrial and social revolution. )
Scientific medicine also makes ])ossil)]e
survival of the elderly individual despite
the progressive ravages of chronic dis-
eases which as yet defy cure or i)reven-

tion. \'()ur weapons are such that you
will ])v .able to comfort and give hope to
an extent undi'eamed of e\en a short gen-
eration ago. Modern scientific medicine.
li()\\e\er, goes fiu'ther : it m;ikes ])ossible
sur\i\;il of the indi\idual not onlv be-
Nond the point of personal ]irofluctivit\-.
beyond the ])oint ol sell -care, but e\en
beyond the point of consciousness or
awareness of self as a person. This power
over i)otentirdly lethal states is a])plied
not only to the aged population, but to
those of any age who have severe irre-
medi;i])le br.ain damage of whatever
cause. Modern medicine now makes pos-
sible the survival of tens of thousands
of severely hanrlicapped children. These
fellow human Ijeings in unprecedented
numbers will require contininng special
care. Will they receive relatively less care
than other fellow human beings who are
potentially self-sufficient ? Should they
receive less ? Or, at this stage of our
culture, is any human lieing entitled to
the best that medicine can oft'er ?

\\'hat of the nfillions of citizens who
are culturall}- and financiallv deprived ?
How is the benefit of modern medicine
to be brought to them ? Shall we as phy-
sicians wait for education to raise them
to economic and social self-sufficiency?
What is our ol)ligation as physicians to
act to l)ring the lienefits of medical care
to all who recjuire it? Is the practice of
medicine j^rimarily an economic ])rivi-
lege? Or is it ])rimarily a social obliga-
tion? I doubt that we could set down
workable answers to these questions this
afternoon, but 1 sincerely ho]:)e we do not
disagree that the basic ethic of medicine
which you have here today renewed calls
upon you to involve yourself in the
solution of such ])roblems according to
\()ur "ability and judgment" and for the
benefit of all patients.

A second form of renewal is also im-

Vol. 49. No. 3

MEDICAL SCHOOL SECTION

plied in the Hippocratic Oath, and that
is the maintenance of professional com-
petence thronghout your career. It seems
strange to speak of maintaining com])e-
tence when each of you feels that most
of your clinical education lies ahead of
you in internshi]), residency, and fellow-
ship. Vet, t()da\- is a watershed in each
of \-oiu" personal, ])rofessional histories,
and from this da\- forward vour indivi-
dual careers will take different paths de-
termined in part hv chance, hv circum-
stances, hut in greatest measure hv vour
voluntary choices.

Those of you who have read .Vldous
Hu.xlev's no\el entitled Island will recall
that on the island there are voices con-
tiinially calling out, "Here and now,
hoys'" and "Attention, attention." The
inhahitants trained myna hirds to speak
these words as a program of preventive
psychotherapy. "Attention" to the "here
and now" is the hasis for resolving proh-
lems and questions as they arise. This
pre\ents the slow, massive accumulation
of unfulfilled good intentions. One of the
major functions of your education at the
I'niversity of Maryland has Ijeen to focus
your attention on the here and now of
good medicine and medical science. Pnit
from this point forward, there will he
lewer and fewer indi\iduals to say to
_\ou, "ifere and now, attention." Each
of you will ha\e to develop your own
reminders and activator mechanisms. As
physicians you are deprived of luxury
fully enjoyed hy most others : that of
postponing decisions and actions. When
the patient calls you, it is a here-and-now
situation in which he expects not onlv
the hest you have to offer, but also that
\()ur hest will not he less than the hest.
^'our social contract theretore re(|uires
the regular renewal of vour ability and
knowledge.

As is evident, medical schools assume

responsibility for preparing future phy-
sicians who will contribute to the revo-
lution of knowledge, recognize and al)ide
by the need for ethical renewal, and en-
gage in lifetime learning. The attempt
to achieve these goals has led to a small
.scale re\()lution in the concepts of med-
ical education. This is exemplified by the
continuing intensive study of its program
by the University of Maryland. Educa-
tion is shifting its emphasis from content
to process. We no longer believe that
mastery of the traditional curriculum in
medical school is an adequate basis for
40 years of productive service. Rather, it
is the continuing ])rocess of education as
undergone hv each individual, first as a
student, later as a physician, that is of
l)rime importance. In order to gain
better understanding of this process, the
intellectual and non-intellectual charac-
teristics of medical students ha\e Ijeen
intensively studied.

Diversity in student bodies has become
a l)v-word. ( Libert}', fraternity and di-
versity is the current slogan. ) There is
growing awareness and appreciation of
the diverse talents and interests students
bring to medicine, because medicine is
enriched by these. But ultimately diver-
sity encounters and nuist accept stringent
limitations. The scientist-investigator in
medicine cannot estal)lish his own rules.
'Vo achieve recognition, he nuist produce
creditable research in accord with estab-
lished standards. The ])hysician has a
wide choice of careers, but having chosen
he is no longer free to exhibit diversity
in standards of ])ractice or ethics.

One of the ])rovocative conclusions
wliich is emerging from studies of med-
ical education is that the most important
objective is not the ac(|uisition of a body
of information or set of skills, but rather
the development of appropriate attitudes
and \alues. More si~)ecificrdly, the set of

July. 1964

liVLI.RTlS OF THE SCHOOL OF MEDICIXE. UXH-ERSITV OF MARVLAXD

\;ilut's vou brought to Marvlaiul and from these l)y the pubhc. But there is
retined while liere will in larger measure growing interest in measuring the dis-
than vonr innate ability or present knowl- crepancy between actual and ideal prac-
edge determine your ultimate contribu- tice, in developing the capacity to assess
tion as physician or scientist. It is in the extent to which the potential benefits
accord with these values that you have of medical service are realized in fact.
given relative weights to the practical Such research will eventually make pos-
considerations influencing your choice sible the systematic and objective deter-
of internshiji. Similarly, your scale of mination of the quality of patient care,
values will ati'ect your choice of residency Historically, it has been the preroga-
and its duration. Studies of the full-time tive of the medical profession to deter-
practicing physician who offers general mine optimum standards of practice on
care to his patients reveal that, ten years the basis of professional judgment. The
after graduation, his concept of respon- notion of external monitoring is repug-
sibility and the number of years of nant. l)ecause only the physician can or
residency training after internship are should determine what is medically cor-
the factors that correlate i)ositively with rect. Xonetheless, the objective study of
the calil)re of his performance. the consequences of treatment in no way
Studies of physicians by behavioral infringes on his professional prerogative,
scientists substantiate what we all sus- One hundred years ago. reputable physi-
pect. namely that a physician is no super- cians in leading medical centers were con-
man. He is all too human, though happily vinced on the basis of their extensive
endowed with such abnormal character- personal experience that blood-letting
istics as high intelligence, inordinate was beneficial to patients ill with pneu-
capacity for achievement, far more inter- nionia. It required the statistical analvses
est in science and far less concern with of Professor Louis to demonstrate con-
tinancial gain than the average college vincingly and for all time that l)lood-
graduate. He performs regularly at the letting reduces the chances of survival,
highest level of competence in two spe- Unfortunately. I must tell vou that this
cihc circumstances : First, when he prac- same conclusion had been equallv firmlv

tices ni an environment in which high
standards are expected and maintained.
and, second, when he has a highly devel-
o]ied sense of viewing his patients as
jK'rsons and views his responsil)ilitv to

established 22 centuries earlier l)y a re-
nowned (ireek phvsician.

The plain fact is that the potential and
potency of modern therapeutics, whether
preventive or curative, make it increas-

them as an obligation to provide the best ingly important that there be objective
possible appropriate medical care. means of assessing the results of treat-
Medical education is drawing upon the ment. Quality control of medical care is
techniques of the social and behavioral the legitimate responsibility of the physi-
sciences which are necessary and useful cian. Xow his personal judgment in this
in the analysis of the educational process, will be augmented, just as modern lal)ora-
Moreover. they are essential for the study tory ])rocedures augment his judgment
of the heart of medical practice, which is in diagnosis. Societv has invested huge
patient care. In the past, and in large sums of money in medical research: it
measure still today, the brilliant advances has an understandable interest in our
of medicine have generally been equated assurance that there is fair return on the
with the actual recei])t of full benefits investment.

J'ol. 49, Xo. 3

MEDICAL SCHOOL SECTION

There are important educational rea-
sons for expeditinj;^ tliis development.
The major puri)ose of vonr medical edu-
cation has heen to prejjare \()U for vour
future role in providing care. The appro-
priateness and soundness of your educa-
tion is measured therefore not 1)V vour
knowledge and skills as such, hut hy the
quality of care your patients will receive
at your hands. Without ohjective meas-
ures of the care actually received we can
only make general judgments as to the
effectiveness of modern medical educa-
tion, and today it is too expensive, too
complex, and too important to he guided
1)}- rough judgments. Medical schools
will actively promote research in the
(luality of patient care. This will have the
same influence on future students as does
ongoing hiologic research, elevating their
expectations and providing incentive for
the exploration of new fields. The results
of such research will provide essential
feedl)ack to physicians, hospitals, and
medical schools.

In the course of your career you will
profit from the closer working relation-
ships which will develop between schools
of medicine and the practicing physician.
Medical centers will form educational
networks with outlying hospitals and
health centers for the education of interns
and residents and postgraduate instruc-
tion of pliN'sicians. In this way, the learn-

ing resources of the medical center will
he more e(|uital:)ly distributed among all
ph}sicians. As physicians in practice you
will ha\e in the near future a more ex-
])licit obligation to improve vour self-
education above and bevond reading
medical books and journrds, attending
hospital and medical society meetings,
courses, and annual meetings of profes-
sionrd associations. Work has already
l)egun to develop carefully designed edu-
cational programs which will expedite
your ac(|uiring the latest information, re-
lunng or acquiring new skills, without
undue sacrifice of time from your prac-
tice. You will ha\e available to you l)oth
the effective means of learning the latest
developments and of realistically testing
yourself on your new knowledge and
competence. This will be your personal
"lifetime learning."

As you see, you are the inheritors of
these many re\olutions in medicine and
of the ethical obligation to channel these
for the benefit of patients. It must seem
whimsical or even farcical to an outsider
that an ancient oath should be given such
prominence by a school attesting to the
continuing productive revolution in med-
ical science. But on behalf of your future
patients, I rejoice with you in this, your
first personal renewal.

2530 Ridge Avenue
Evanston, Illinois

JuJ\. 1064

ABSTRACTS

of articles by
faculty and alumni

Iron Metabolism in Premature Infants (I.
Absorption and I'tilization of Iron as
Measured by Isotope Studies) — Martin
K. Gorton, Ray Hcpncr, and Joscpli B.
Workman, M.D.

/. Pcdiaf. 63:1063, 1963

Fourteen liealtliy premature infants ranging
in age from one to ten weeks were given one
microcurie of iron-59 incorporated in the usual
formula and later analyzed for absorption and
utilization rates. Seven infants were given the
iron-containing formula and the remainder
were fed an iron-free formula prior to the
administration of a test dose. An iron load of
325 to 1,025 micrograms of elemental iron
was given with the isotope.

Absorption of iron-59, ranging from 6.8 to
74.0% (mean 31.5%), was found to be inverse-
ly related to the quantity of stable iron in the
load and to be unaffected by previous gastro-
intestinal exposure to iron.

A correlation between tagged iron absorp-
tion and growth rate was demonstrated. The
course of absorbed isotopic iron was traced by
surface counting of internal organs and blood
sampling. A concentration of activity was
found over the sacrum, spleen, and liver at 48
to 72 hours.

Incor]Joration of iron into hemoglobin cal-
culated from the iron-59 activity in the blood
displayed a wide range with a mean of 15.3%
of the quantity of iron in the test dose. The
amount of iron utilized in blood formation
correlated significantly with growth rate. The
severity of anemia and degree of erythropoietic
activity appeared to affect positively the imme-
diate utilization of absorbed exogenous iron.

Premature infants absorb and utilize iron at
a greater degree during the first ten weeks of
life than in later infancv and childhood.

Multiple Lipoidal Histiocytomas with Re-
gression— Harry M. Robinson, Jr., Louis
E. Harmon, and Harlan I. Firminger.
Arch. Dcrmat. 88:660, 1963

The case history and postmortem findings
of a 47-year-old Xegro female with numerous
cutaneous nodules are reported.

The lesions characteristically passed through
I)roliferative, granulomatous, xanthomatous,
and healing phases.

The term "lipoidal histiocytoma" would
seem preferable for this condition.

The features indicate a type of histiocytoma
which has the ability to phagocytose lipids yet
later undergo regression with reticulum and
ceroid formation.

Tracer and Non-Tracer Potassium Fluxes
in Frog Sartorius Muscle and the Kine-
tics of Net Potassium Movement — R. A.

Sjodin and E. G. Henderson.
/. Gen. Physiol.. 47:605, 1964.

Experiments were performed to test the ap-
plicability of permeability kinetics to whole
frog sartorius muscle using K-*- ions as tracers
of potassium flux. The whole muscle was found
to obey closely the kinetic laws expected to
hold for single cellular units in which the
potassium fluxes are membrane-limited and
intracellular mixing is rapid enough not to
introduce serious error. In a 5 m.M K Ringer's
solution, potassium efliux was very nearly
equal to influx when the rate constant for K^-
loss was applied to the whole of the muscle
potassium. Over a fairly wide range of external
potassium concentration, the assumed unidi-
rectional fluxes measured with tracer K-*-
showed good agreement with net potassium
changes determined analytically. The specific
activity of potassium lost from labeled muscles
to an initially K-free Ringer's solution was
measured as a test of the adequacy of intra-
cellular mixing. The results were those ex-
])ected for a population of cells with uniformly
distributed intracellular K-*-. A small deviation
was encountered which can be attributed
either to a dispersion of fiber sizes in the
sartorius or to a possible small additional cel-
lular compartment in each individual fiber.
The acklitional cellular compartment, should
it exist, contains from 0.5 to 1 per cent of the
muscle potassium. This is evidently not large
enough to interfere seriously with the applica-
bility of permeability kinetics to the whole
muscle.

Vol. 49, Xo. 3

ALUMNI ASSOCIATION SECTION

sible for any success the Association achieves. It is this
group tliat needs to be greatly increased in numbers
and work expended and would it only our l>altiniore and
nearby Aledical Alumni would offer their services.

Next, I wish to pass on a few thoughts about our
first Maryland Medical Reunion Day. Generally speak-
ing, I believe this day went very well, and this was to
be expected after all the careful planning and effort that
was put forth. The extremely interesting and thrilling
talk by Dr. David Dingman made us all realize we are
handing the torch of medical practice to young men,
who are not only intrepid and daring, but have the
stamina and know-how to tackle any prol)lem.

The highlight of the day was the presentation of the
Honor Award and Medal to Dr. Hugh R. Spencer, who
received an outstanding and prolonged ovation that was
well deserved. Following this event, a luncheon was
served which helped everyone to mix, renew old friend-
ships, and make new acquaintances in the environment
of the John Eager Howard Building. The scientific ses-
sions were numerous and varied enough to suit the
interests of all, and emphasized many new facets of
medical progress.

AA> have learned much from the happenings of this
dav, and with the correction of our deficiencies and
mistakes the next meeting should be more successful.
Your constructive criticisms and suggestions will be
most eagerly accepted, considered, and incorporated
into future jilans.

The banquet, opened by an inspiring invocation by
the Rev. Osborne R. Littleford, climaxed the day with
a very good attendance. Our fifty year graduates were
awarded appropriate certificates and properly recog-
nized. The class of 1964, whose members and their
ladies were guests of the Medical Alumni Association,
was introduced and Mr. Marvin Saiontz, the president,
responded. Then followed the speaker of the evening.
Dr. Jack C. Xorris of Atlanta, Georgia. Good food and
drink contributed to the activities of the night which
ended with a dance.

Please remember that it was Dr. George Yeager, my
predecessor, who laid the foundation of the first Mary-
land Medical Reunion Day, and that it was planned in
a most commendable manner by Dr. Edward F. Cotter
and his Hospital Association delegates, especially Dr.
Arlie Mansberger.

July, 1964

BULLETIX OF THE SCHOOL OF MEDICIXF. UXn-HRSrrV OF MARVLAXD

Thanks arc likewise due Dr. William Triplett and
Mrs. Ciirkin for their efforts on behalf of the Medical
Alumni Association, and Dr. ]-fo\vard P,. Mays, the
Treasurer, for his advice and aid. Mrs. James G. Arnold
and her committee are to l^e heartily congratulated for
such an outstanding Ladies' Day. Dr. J. Morris Reese's
contribution to the Day was obtaining the banquet
speaker.

Special thanks must be given to Dr. William Stone,
Dean of the School of Medicine, and Dr. Theodore
Woodward. Professor of Medicine, for their fine coop-
eration, moral support, and encouragement. There are
manv others to whom we all owe a great inde])tedness
for their efforts in making this Day a success.

In conclusion, I wish to extend my heartiest con-
gratulations and best w'ishes for a most successful year
to Dr. J. Howard Franz, your new President. This
phvsician combines the qualities of an excellent doctor,
an outstanding leader and organizer, a good business
man. and above all a Christian gentleman. Altogether
he should be a most eminent President, and bring to
this office nothing but exceptional achievement. For my
part, sincere thanks for the privilege of serving as your
President for the past term, and my deep appreciation
to each and every person who has helped in the execu-
tion of my duties.

Gibson J- \\'ells, M.D.
President

Student Loan Fund Report

Dr. W^illiam H. Triplett, Executive Secretary to the Medical Alumni Associa-
tion, reports that total contributions to the Alumni Student Loan Fund during the
fiscal year 1963-64 amounted to only $330.00.

Loans in the amount of $800.00 were made during this same period.

The Alumni Association believes the Student Loan Fund to be a very worthy
endeavor, with contributions to the Fund being used exclusively for students at
the SchcKjl of Medicine. The first loan, made in 1959, has already begun to be
repaid. Until such returns from the Fund are received, it is impossible to offer
students additional loans. The Fund is in dire need of immediate and substantial
support. Inquiries should be made to Dr. William H. Triplett. Executive Secre-
tary, Medical Alumni Association. Contrilnitions to the Fund are tax exempt.

xviii Vol. 49, Xo. 3

Alumni Dav 1964

For the first timk, a comliination
of the Aledical Alumni Association's an-
nual meeting with the hiannual meetings
of the Surgical. Medical, Obstetrical and
Gynecological, and Pediatric Societies
took place on the campus, Mav 7, 1964.
In(li\idual programs mailed to all Alum-
ni and former house officers of the Uni-
versity Hospital included a very fine and
liberal scientibc program interspersed by
business meetings and entertainment.

Friday. May 8. 1964, was Medical
Alumni Day. Registration of more than
100 Alumni was completed by 8:45 a.m.

The following alumni registered for
Alumni Day, 1964.

B. M. C. 1904
Howard G. Stevens

Cla.ss of 1908
Lester D. Norris

B. M. C. 1911
William Triplett

P & S 1912
Albert E. Goldstein

Class of 1913
C. Reid Edwards

Class of 1914
L. W. Blake Joseph Lipskey

James C. Brogdem J. U. Roher
J. J. Jenkins, Sr. I. G. Shirkey

Augustus R. Laugier Byron \V. Steele
Nolan D. C. Lewis Austin H. Wood

Class of 1915
Ernest G. Marr

Class of 1916
Harry Goldmann

Class of 1917
Louis A. M. Krause

Class of 1918
John M. Nicklas

Class of 1919
James Brown W. G. Geyer

John A. Buchness M. LeRoy Lumpkin
Eugene L. PMippin H. B. McElwain
Wetherbee P'ort C. Wilbur Stewart

Class of 1920
Louis C. Dobihal Z. Vance Hooper

F. A. Holden J. Morris Reese

Class of 1922
George E. Shannon

Class of 1924
Clewell Howell F. J. Theuerkauf, Sr.

James E. Peterman Alex A. Weinstock
Arnold L. Tabershaw John Zaslow

Class of 1925
Joseph Nataro Sam S. Glick

Class of 1926
Jacob Schmukler

Class of 1927
B. Lenson-Lambros Bernard J. Cohen
Frank K. Morris A. H. Finkelstein

Class of 1929
Joseph N. Corsello William Yudkoff

Class of 1930
Archie R. Cohen

Class of 1931
Walter Kohn Arthur G. Siwinski

Class of 1932
Harry C. Hull Samuel E. Proctor

Arthur Karfgin John E. Savage

Louis F. Klimes

Class of 1933
Lauriston L. Keown Ben Miller

Class of 1934

D. D. Caples
Samuel Diener
George E. Dorman
Robert H. Dreher
John E. Echols
Robert W. Farr
Leon H. Feldman
Sidney Gelman
Herbert Goldstone
Charles L. Goodhand

Edward S. Hoffman
William H. Horan
Reuben l^eass
Helen 1. Maginnis
Hugh B. McNallv
Milton S. Sacks
John N. Snyder
C. M. Stutzman
H. Lawrence Sutton

Class of 1935
E. I. Cornbrooks, Jr. Howard B. Mavs
Edward F. Cotter L. H. Mills
Joseph B. Gross P. Polani

L F. Hartman H. M. Robinson, Jr.

J. R. Heshinian

Class of 1936
Harry C. Bowie Gibson J. Wells

Joseph R. Myerowitz

Class of 1937
S. T. R. Revell, Jr. C. Parke Scarborough

J'.ilw 1964

Dr. Nolan D. C. Lewis. '14. receives 50 year certificate from Dr. Wm.
H. Triplett. executive secretary. Medical Alumni Association.

Dr. Gib.son J. Wells,
retiring President

Dr. J. Howard Franz, President
.\Iumni Association 1964-65

Dr. M. A. Robbins. '44

Dr. Theodore E. and Celeste Woodward, Dr. Harry J. Robinson, Jr.

Drs. Robert W. Buxton, James ('. Brandon, '14, and Chas. Reid Edwards, '13, seen at

reunion.

Dr. C. Wilbur Stewart.

Dr. T. Nelson Carey attended.

Dr. E. J. Guy, Class of 1944.

Dr. Isidore Tuerk, Commissioner of

Mental Hygiene, State of Maryland,

saw son graduate.

Dr. Howard B. AIcElvain

Drs. Helen I. Maginnis and Sylvio A. Alessi

BVLLETIS OF THE SCHOOL OF MEDICIXE, LWirERSITV OF MAKVLAXD

Class of 1938
John A. Wagner T. E. Woodward

Celeste Woodward

Class

Harry M. Beck
Henrv A. Briele
Richard M. Corbitt
(Jeorpe S. Grier, III
Leonard L. Heimhoflf
Benjamin Isaacson
Wm. H. Kammer. Jr.
I. L. Marks
D. L. Keimann

of 1939
Wilbur C. Thomas
John A. Moran
Walter J. Pijanowski
Ramsav B. Thomas
John V. Urlock. Jr.
F. B. Whitworth
Milton J. Wilder
Sol Wilner

Class of 1940

Lester H. Caplan
Edward O. Daue
Ben H. Imloes
James K. Karns
F. Ford Loker
Ross Z. Pierpont

R. C. V. Robinson
Samuel V. Tompakov
W. H. Townshend
W. Earl Weeks
R. T. Williams

Class of 1941
Elizabeth B. Sherrill

Class of 1942
Karl A. Dillinger Theodore Kardash

J. C. Furnari William T. Raby

Class of 1943
Elizabeth Acton John S. Haught

Harrv Cohen Hal Ingram

William R. Eaton David R. Will

Class of 1944

Frank J. Brady Ernest G. Guy

Rowell Cloninger Donald W. Mintzer

R. Adams Cowley Louis J. Pratt, Jr.

James A. Doukas Morris A. Robbins
William Carl Ebeling Charles E. Shaw
J. Carlton Godlove

Class of 1945
John M. Dennis Stanley R. Steinbach

J. B. Ganev Yasushi Togo

J. R. McNimch

Class of 1946
Joseph D'Antonio Irl J. Wentz

James A. Sewell Joseph B. Workman

Class of 1947
John F. Benson Marv E. Matthews

Robert C. Duvall Adalbert F. Schubart

A. R. Mansberger, Jr. John P. White, 3rd

Class of 1948

B. Schwartz F. J. Theverkauf, Jr.
Norman Tarr William S. Womack

Class of 1949
Martin K. Gorten Carolyn W. Watson

John F. Strahan Frank Y. Watson

Gilbert L. Nicklas Lillian K. Ziegler

Class of 1950
F. J. Borges Wm. H. Yeager, Jr.

Class of 1951
Robert K. Arthur, Jr. F. S. Gardner, Jr.
Wm. H. Edwards, Jr. H. Gray Reeves
James P. Gallaher Eugene B. Rex

Class of 1952
B. A. Addison Michael J. Foley

Class of 1953
Wyand F. I)oerner,Jr. Robert T. Singleton

Leonard H. Flax

Karl H. Weaver

Class of 1954

Robert B. Goldstein
John F. Hartman
Ben F. Knotts, Jr.
David A. Levy
Beverly Nangle

Gerald Nangle
Riva Novey
J. Walter Smyth
H. R. Weiss
Kenneth H. White

Class of 1955
Donald H. Dembo Vincent S. Mikoloski

Marvin A. Goldliner Leonard J. Morse
C. Ronald Koons

Class of 1956
Daniel G. Anderson K. M. Klatt

Class of 1957
John T. Bulkeley Chas. M. Henderson

Class of 1959

A. C. Broccoli
Gilbert N. Feinberg
Carlton S. Halle
Robert S. Holt
James P. Jarboe
Jorge O. Just

Ramon Roig

H. J. Rubenstein

Lee Russo

C. E. Rybczynski

Arthur A. Serpick

Class of 1961
Carl F. Berner Gerald A. Hofkin

K. L. Cloninger M. B. A. Oldstone

Leonard W. Glass

Class of 1960
Jerome M. Read

Class of 1962
Kenneth William Tuttle

Class of 1963
Hector L. Rodriguez

The opening remarks were delivered by
Dr. Gil)son J. \\'ells. President of the
Mechcal Ahiinni Association, and an
additional welcome was given by Dr.
A\'illiam S. Stone, Dean. Dr. David L.
Dingman, assistant resident in Surgery
at University TTos])ital and a member
of the National (ieogra])hic 1963 Alt.
Everest Expedition, spoke on "A Per-
sonal Account of the Successful Ameri-
can Assault on Alt. Everest."

Vol. 49, No. 3

ALUMXI ASSOCIATIOX SECTION

Dr. Hugh R. Spencer receives Alumni Award and Gold Key from Dr. J. Gibson Wells, President of the
Medical Alumni Association, as Dr. William S. Stone looks on.

At 10:00 A.M.. the scientific sessions
of the Medical, Surgical, Ohstetrical, and
Pediatric Societies were held, followed
l)v the annual .\lunini l)usiness meeting
in Chemical Hall. At this time the Alum-
ni Honor Award and Gold Key was pre-
sented to Dr. Hugh R. Spencer, a mem-
l^er of the Class of 1910 and Emeritus
Professor of Pathology iu the School of
Medicine.

In presenting Dr. S])encer for this
award. Dr. Wells delivered the follow-
ing citation which, in part, said : "Today
we are Ijestowing the Medical .Alumni
Association Honor Award and Cold Key
to a (juiet, friendl}-. dignified gentleman,
who will celehrate his 76th hirthday on
this Sunday, May 10. The life of this
devoted and loyal alumnus has heen cov-
ered in detail in a most excellent manner
in several issues of the Bui.i.kti.n. . . .

"However, there are certain high-
lights I shall enumerate hriellv. He was

horn in jarrettsville, Harford County, in
Maryland.

"After his return, following the World
War in UHS, to the .School of Medicine,
he was made Professor of Pathology and
Head of the Department. We all know
how he huilt up his department to an
excellent degree of efliciencv, and how he
also helped raise the standards and re])U-
tation of the School hv ser\ing on the
Admissions Committee, heing a real
friend and councillor to any seeking help.
The door to his office was always open
and he more than once poured oil on
the troul)lesome and perj)lexing prohlems
of students, faculty, and associates alike
with his sage advice and dry humor. . . .

"In 1956 he retired and, on a day
named in his honor, was paid high trih-
ute by all his colleagues and former stu-
dents from all over this vast planet. Since
then he has enjoyed a well-deserved rest
in com])anv with his loving and devoted.

Jiilx. 1964

Bl'LLETIS or Tin- SCHOOL OF MEDICINE, UNU'ERSITY OF MARYLAXD

chanuiiig wife. :\ childhood sweetheart. to advance the progress of our medical

iiistitiiti(jn.
••Therefore, todav it is niv good f(jr- "^ present to you a very close and dear

tune to have the privilege of bestowing f'^i^'icl for your recognition— Dr. Hugh

the Medical Alumni Association Honor ^"^^ -^pencer.

Award and Gold Key to a former teacher Following the presentation l)y Drs.

and professor, a councillor and adviser. ^\>lls <^"<1 Stone, a rising ovation and

a scholar, and a gentleman of the old applause was tendered Dr. Spencer.
school, hut above all. to a loval alumnus Then followed a brief business meet-

who has gi\ en of himself so unseltishly ing the minutes of which follow.

TREASURER'S REPORT OF ALUMNI ASSOCIATION, 1963

The fiscal year ended April 30, 1963, with the Alumni Association in a sound
financial position.

Opening Balance, May 1, 1962

^Maryland National Bank (Checking Account) $ 4,356.10

Eutaw Savings Bank (Savings Account) 6,249.01

Balto. Fed. Sav. & Loan (Student Loan Fund) 1,023.49

$11,628.60

Receipts, Mav 1, 1962— April 30, 1963 $23,485.34

Disbursements, May 1, 1962— April 30, 1963 16,809.33

Balance $ 6,676.01

Closing Balance, April 30, 1963

Maryland National Bank (Checking Account) $ 540.47

Eutaw Savings Bank (Savings Account) 15,322.80

Balto. Fed. Sav. & Loan (Student Loan Fund) 1.441.26

Total $17,304.53

Details of Receipts and Disbursements will appear sejxirately in the Bulletin
following the auditors' report for 1963.

Closing balances for the past three years:

1961 $ 4.064.22

1962 11.628.60

1963 17,304.53

This represents a real endeavor to secure for the Association a more favorable
financial position following a long period of a policy of financial insecurity.

The important reasons for stability are obvious if the organization is to become
more progressively effective.

This year a curriculum vitae file of graduates was begun with the 1963 graduating
class. This is to be a continuing endeavor anticipating an extension to cover all
graduates of the Medical School. The value of this jMogram to the Association and
the Medical School is obvious and the expenditure will be a worthy one. The plan
as presently conceived will, in addition to current photographs of all graduates and
a basic file of information, encourage accunnilation of significant information. We
anticipate soliciting units possibly on a five to fifty year basis relating to graduation
anniversaries. Thus your record will be periodically updated.

Tentative plans for a combined alumni center for the Baltimore Campus are

xxiv Vol. 49, Xo. 3

ALUMNI ASSOCIATION SECTION

under discussion. Our sound financial status will place us in a very favorable
financing position for this endeavor as it develops.

A substantial increase of the student loan fund is anticipated. At present this
fund — administered by the student loan fund committee of the Alumni Association —
is a modest one and your contributions to this very worthy activity of the Associa-
tion are earnestly solicited.

Paid Membership for 1963 is 1,476 — this is a sizable representation but should
be much larger. A growing membership, continued sound fiscal policy and your
support of the Medical Alumni Association will insure a greatly increased scope
of effectiveness.

I am pleased to have had the privilege of presenting this increasingly favorable
report for 1963.

Respectfully submitted,

Howard B. Mays, M.D.
Treasurer

Minutes of the Annual Meeting of

the Medical Alumni Association,

University of Maryland

(Held in conjunction with the First
Maryland Medical Reunion)

May 8, 1964
The annual business meeting of the
Medical Alumni Association was called
to order by the Alumni President, Gibson
J. Wells, M.D.

Dr. Howard B. Mays, Treasurer, re-
ported :

Checking Account, Mary-
land National Bank $6,047.32

Savings Account, Maryland

National Bank 5,000.00

Funded Reserve, Eutaw

Savings Bank 15,902.75

Student Loan Fund, Balto.

Fed. Sav. & Loan 1,007.51

$27,957.58
He announced that Dr. George H.
Yeager heads a subcommittee to assist
in the planning of a joint Faculty-Alumni
Facility.

Dr. Wells called our attention to the
posted Necrology Report, following
which a moment of silence was observed
for our departed colleagues.

Dr. Hugh R. Spencer of the B.:\1.C.
Class of 1910 was recipient of the Honor
Award and Gold Key presented by Dr.

Wells and Dean Stone. Dr. Wells intro-
duced Dr. Spencer recalling his 37 years
as Professor of Pathology at the School
of Medicine where he had won the ad-
miration and friendship of the faculty
and students. Dr. Spencer was remem-
bered for his outstanding efforts in ad-
vancing the standards and reputation of
our School and is considered one of our
most loyal Alvmini.

Dr. Spencer's remarks upon this occa-
sion were very v/arm and expressive. Fie
recalled the earlier days of struggle and
organization of the Department of Path-
ology. Dr. Spencer was most appreciative
to his colleagues for their advice and firm
friendship throughout his years as Pro-
fessor of Pathology. For him this award
was. "The greatest honor and highest
point of my life."

Dr. \W'lls reported that to date the
student loan fund had received $5,907.81
in subscriptions and made 14 loans to-
taling $4,900.30, leaving a balance of
$1,007.51.

The report of the Nominating Com-
mittee was rendered by Dr. Frank K.
A [orris. Chairman of the Nominating
Committee. The following oftkers were
nominated for the year 1964-65 :

President-elect —

Dr. C. Parke Scarborough

Julx, 1964

BLLLETIX OF THE SCHOOL OF MFPICINE. UNirEk'SlTV OF M.lRVL.LXf)

Secretary —

Dr. Thomas H. Connor
Treasnrer —

Dr. Walter E. KartVin
Vice-Presidents —
Dr. F. A. Holclen
Dr. Robert \\^ Farr
Dr. John E. Moran
Three new Members of the Board of
Directors :

Dr. \\"iniam H. Kanimer, Jr.
Dr. Roliert Goldstein
Dr. John D. Young, Jr.
Signed.

Frank K. Morris, AI.D., CJiainnan
George H. Yeager, JM.D.
Harry Beck. M.D.
Louis C. Dol)ihal, M.D.
John F. Hogan, Jr., M.D.
Respectfully,
Francis J. Borges, M.D.
Secretary
Dr. William H. Triplett, Executive
Secretary of the Medical Alumni Asso-
ciation, then presented the Necrology
roster for 1963. which is as follows:

NECROLOGY ROSTER,

1963-64

Koox.s, Earle W.

1924

ROTTENBERG, JOSEPH

1912

Sherman, Louis F.

BMC

1893

MiLHOLLAND, ArTHUR V.

1938

Fenby, John S.

1914

Don Diego, Leonard V.

1940

Hogg, Gory

P&S

1895

Booker, Robert F.

1902

Favour, Richmond, Jr. .

1904

Cooper, Charles F.

1897

Bunn, James H., Jr.

1936

Babcock, W. Wayne

P&S

1893

Whisnant, Albert M.

P&S

1893

FiDLER, AkDVERN K.

1927

McGuiRE, William P.

BMC

1903

FucHs, Abner M.

1925

Bubert, Howard M.

1920

Kepple, Adam S.

1909

Welfeld, Alvan a.

1938

MiTciif;LL, George W.

1896

Rabinowitz, Jacob H.

1934

MoLOFSKY, Leonard C.

1938

Makti.v, William F.

1920

Pruitt, Harrison A.

BMC

1910

Wright, J. LeRoy

BMC

1908

King, Victor F.

1951

Insley, J. Kno.x, Sr.

1908

McMuLLEN, John

1895

Stone, William L.

BMC

1910

Whipple, Ernest E.

P&S

1908

Richardson, Charles R.

1903

Peters, H. Raymond

1922

Rrow.v, Joseph L.

1918

Perras, Louis A.

BMC

1911

Dailey, William Paul

1929

Flachs, Adolph

BMC

1907

Forbes, Sherman B.

1918

ReH MEYER, W. O.

1931

Meyer, Alvin

1939

Franklin, Philip L.

1936

D ALTON, William B.

1918

GuTMAN, Isaac

1934

Morrill, David S.

BMC

1897

Lane, Edgar W.

1915

FiNKELSTONE, BeNJAMIN B.

P&S

1910

MacDougal, Wilbur E.

P&S

1904

Naumann, Albert A.

1915

Berry, Erwin P.

1930

Grounds, Wilbert Lee

P&S

1910

Harman, Howard E.

P&S

1911

Agnew, John R.

1914

Weinstein, Jack

1930

Troxler, Raymond M.

1914

Shochat, Albert J.

1931

Schapiro, Abraham

1914

Rosenberg, Herbert J.

1908

Waller, W. Kennedy

1936

Dees, Daniel Alfonso

BMC

1903

Daves, John Thomas

1917

Hosmer, Merrill F.

P&S

1914

Bis HON, Everett L.

1916

Rolenson, Julio R.

1916

Hugg, John Henry

1935

Ahroon, Carl R.

1901

Vilella, Felix M.

P&S

1909

Henderson, Clair C.

1914

Wanner, Jesse R., Jr.

1939

Mitchell, William M.

1905

Brillhart, Harry L.

P&S

1912

Dries, Charles L.

1911

Clark, Sydenham R.

1905

HoRiNE, Cyrus F.

1919

Lovill, Robert J.

1910

Jones, Ezra A.

BMC

1907

Powell, Jesse A.

P&S

1907

Fessler, William

BMC

1907

I.arooue, Herbert

BMC

1903

Continued p. xxxiv

'ol. 49. No. 3

ALUMNI ASSOCIATION SECTION

Class of 1914

Charles W. Armstrong, M.D.

1216 W. Innes St., Salisbury, N. C. 28144

Yates M. Barber, M.D.
Tidewater, Va. 22566

Geo. Wm. Bishop, M.D.
Pasadena, Md. 21122

Wm. p. Black, M.D.

Ill Capitol St., Charleston, W. Va. 25301

LowRiE W. Blake, M.D.

5609 7th Ave. Dr. West. Bradenton, Fla. 2,iS0S

O. H. BoBiTT, M.D.

863 24th Ave. X., St. Petersburg, Fla. i2,7U

A. D. Bogert

Address not listed in 1963 AM A Directory

James C. Brogdex, M.D.

108 W. 6th St., Tulsa, Okla. 74103

Morton M. Brotman, M.D.

212 S. Orange Ave., Apt. 10, S. Orange, N. J.

07079

Manuel G. Carrera, M.D.

101 N. Union St., Fajardo, P. R. 00648

Arthur Casilli, M.D.

618 Newark Ave., Elizabeth, N. J. 07203

Everett L. Cook, M.D.

4125 Arkansas Ave. N.W., Washington, D. C.

20011

Gu-BERT L. A. Dailev, M.D.

618 N. 3rd St., Harrisburg, Pa. 17101

Theodore McCann Davis, M.D.

108 Vannoy St., Greenville, S. C. 29601

Walter Lee Denny, M.D.

3908 X. Charles St., Balto., Md. 21218

Chauncey E. Dovell, M.D.

62 S. Boxwood St., Hampton, \'a. 23369

Escheverria y Mora, Jose Ramon, M.D.
Castillo del Principe, Havana, Cuba*

Rkhaki) I. Esslinger, M.D.

3720 Glenmore Ave., Balto., Md. 21206

Attie Thompson Gordo.v, M.D.
Spencer, W. Va.

Geo. Garland Grazier, M.D.

102 River St., Hollsopple, Pa. 15935

Cec H. Starke Hassell, M.D.

411 S.W. 29th Ct, Miami, Fla. 33135

Howard Carrington Heilman, M.D.
Elderton, Pa.

Aaron L. Holstein, M.D .

174 Undercliff Ave., Bronx 53, X. Y.*

Jesse J. Jenkins, M.D.
Farinington, W. Va. 26571

James W. Katzenberger

44 Cedar Rd., Severna Park, Md. 21146

Harry Stanley Kuhlman, AI.D.
Sharptown, Md.

Herbert Leonard Langer, M.D.

212 Beach 69th St., Far Rockaway, X. Y. 11692

Augustin R. Laugier, M.D.
Box 298, San Juan, P. R. 00902

AIorris B. Levin, M.D.

218 E. Univ. Pkwy., Balto., Md. 21218

X'oLAN D. C. Lewis, M.D.
Rt. #5, Frederick, Md. 21701

Joseph Lipskey, M.D.
Odenton, Md.

John F. Lutz, M.D.

72 Southgate Ave., Annapolis, Md. 21401

Charles L. Magruder, M.D.

1010 X. Bundry Dr., Los Angeles. Calif. 90049

John E. Maher, M.D.

96 Third Ave., Long Branch, X. J. 07740

Erwin AIayer, M.D.

The Esplanade Apts.. Baltimore. Md. 21217

John Vincent McAninch, M.D.

308 W. Lincoln Ave., McDonald, Pa. 15057

Albert D. McFadden, M.D.

4313 Marble Hall Rd., Balto., Md. 21218

Challice Haydon Metcalfe, M.D.
Sudlersville, Md. 21668

Ma J. Alfred Mordecai, M.D.

806 S. Hawthorne Rd., Winston-Salem, X. C.

28403

Lt. Col. Frank ^L Moose, M.C, USA
4501 Dalton Rd., Chevy Chase, Md. 20015

John Charles O'Neil, M.D.

P. O. Box 158, Savannah, Ga. 31402

* Last known address.
Jul\. 1Q64

* Last known address.

BVLLETIX ()!■' Tllli S^ IIDOL OF MF.niCIXE. I'MrF^R'SITV OF MARVLAXD

Class of 1934 — University of Maryland
Celebrates at Reunion

Class of 1934 (left to right): J. X. Corsello. E. Levi. W. Sullivan. J. Conn. G. Yeager. Mabel Silver,
S. Brauer, L. S. Heck. S. Alessi. H. Cohen, and J. Haney.

Maxuel E. Pljadaz-Dias, M.D.

1611 Colon Ave., Santurce, P. R. 00911

William F. Rice, M.D.

1965 5th Ave., San Rafael, Calif.*

Walter L. Richards, M.D.

Box 11, Rt. 4, Charlottesville. Va. 22901

Joseph U. Rohr
Roanoke, Va.

Richard O. Shea, M.D.

25 Sanford P., Bridgeport, Conn. 06604

Ivv G. Shirkev, M.D.

Albemarle Apts., 1830 17th St., N.W.,

Washington, D. C. 20009

Byron Wm. Steele, M.D.
Box 248, Mullens, W. Va. 24863

Frank Gregory Strahan, M.D.

Red Gate Farm, Williamsville, Vt. 05353

Geo. Loutrell Timanus, M.D.

1307 Maryland Ave., Baltimore, Md. 21201*

Thurman Elroy Vass, M.D.
Box 167, Bluef^eld, W. Va. 24701

Wm. Sebastian Walsh, AI.D.

24 Greaton Dr., Providence, R. I. 02906

H. H. Warner, M.D.

2604 Garrison Blvd., Balto.. Md. 21216

David Tressler Williams. M.D.
21 Hall Ave., Newark, Ohio 43056

Austin H. Wood, M.D.

Med. Arts Bldg., Baltimore, Md. 21201

* Last known address.

Last known address.

J 'ol. 49, \'o. 3

Class

NOTES

Elsewhere in this edition you will
find a "tear out" page, for reporting
Ahiinni Ncii's to the Bulletin. This is
not an idle gesture.

Your achievements, jellozv alumnus,
arc uj interest to your classmates. They
constitute a rezvard to the faculty, are a
challenge to the younger physicians, and
are an item of prestige for the Univer-
sity. Please cooperate zvith us by for-
warding nezvs of yourself or any alumnus
to the Bulletin. Thank you.

Class of 1929

Jacob H. Conn was the principal
speaker at the scientific seminar and at
the award banquet of the Michigan So-
ciety of Psychosomatic Dentistry and
Medicine, held in Detroit during the
month of April. 1964. Dr. Conn's topic
was, "Psychiatric Principles in Patient
Management."

Class of 1934

William B. Soltz of 1749 Grand Con-
course, Xew York 5?i. X. Y., has l)een
elected to fellowshij) in the American
College of Physicians. Dr. Soltz was
inducted at the annual meeting of the
College at Atlantic City in April, 1964.
Dr. Soltz has completed and published
several research studies on "The Piio-
chemistry of Aging" in collaboration
with Dr. Bacon F. Chow of the Johns
Hopkins School of Hygiene and I'ul)lic
Health.

Class of 1937

Joseph A. Muse, Jr., now serves as
chief of Medicine at the Bon Secours
hlospital in lu'dtimore.

Class of 1943

Myron J. Myers has announced the
removal of his office to 4419 Falls Rd.
(at Cold .Spring Lane) in l^>altimore.

Class of 1944

Champe Clark Poole of 2800 Green
St.. Harrisburg. Pa., has been named
President of the Dauphin County Med-
ical Society for 1964. Dr. Poole also
serves as chief of Orthopedics at the
Harrisburg Polyclinic Hospital, where
he is also coordinator of the Department
of Orthopedics and is acting chief of the
Department of Rehabilitation. Dr. Poole
has also served recently as President of
the Orthopedic Section of the Pennsyl-
vania Medical Society and is currently
President-elect of the Harrisburg Aca-
demy of Medicine.

Class of 1945
Frank J. Ayd, Jr., received the hon-
orary degree of Doctor of Laws from
Xavier L'niversity, Cincinnati, Ohio, on
June 3. 1964. Dr. Ayd also delivered the
commencement address.

Class of 1947

Joseph W. Blevins, who has served

as medical director for the Instrument
Department of the General Electric Co.
in Lynn, Mass., has been appointed med-
ical director for the Olin Aluminum Co..
Hannibal, Ohio, where he assumed his
new responsibilities on June 15, 1964.

Dr. Blevins will now l)e responsible
for organizing a complete industrial med-
ical service for a new aluminum rolling
mill that has recently been built in Han-
nibal.

L. J. Bunch, formerly of Alamosa,
Colo., has mo\ed to South Fork, Colo.

Gordon R. Forrer, 20141 James
Couzens Highway, Detroit, has published

July. 1964

BULLETIX OF THE SCHOOL OF MEDICINE. IWirERSITV OF MARYLAND

a paper entitled "The Psyclioanalytic
Theory of Hallucination." This ixqier
appeared in the joiu-nal. Piscascs of tlic
Xcrroiis System (24:1. Dec. 1963).

Class of 1955

Paul C Hudson, former resident in
neurosurgery at University Hospital and
a practicing neurosurgeon in Baltimore,
has joined the medical stafif of the hospi-
tal ship S.S. Hope, in Guayaquil, Ecua-
dor, where the ship has heen stationed
.since Decemher, \963. Dr. Hudson will
remain on duty with the ship through
the early summer of 1964. He is a mem-
her of the fourth rotation team, each team
spending ahout two months each on the
ship to augment its regular staff of more
than 80 physicians, nurses, and other
medical personnel.

The S.S. Hope will remain in Guaya-
(|uil until Septemher, 1964, when it will
sail for Africa.

Class of 1957

Marvin S. Arons of 107 Strand, Gal-
veston, Texas, has been recently elected
to the Society of Sigma Xi. Dr. Arons is
also a member of the New York Academy
of Sciences. He presented a paper at a
recent meeting of the American Society
of Maxillofacial Surgeons and at the
Texas Society of Plastic Surgery. Dr.
Arons has recently ])articipated in the
National Burn Seminar and has been
active in the Association of Plastic Sur-
gery Residents.

Harvey R. Butt, Jr., of 710 Warren
Drive. Annapolis, Md.. has been certi-
fied by the American Board of Anesthe-
siology, the certificate being issued in
A])ril. 1964.

Class of 1958

Stuart H. Brager has recently an-
nounced his association with Drs. Paul
F. Guerin and Watson Kime as director
of the Radioisotope Division of their
Clinical Laboratory which is located at
1010 St. Paul St. in P,altimore.

Richard J. Erickson of 1209 Euclid
Ave., Knoxville, Tenn.. has recently re-
turned from military duty in Germany
and has resumed the private general
practice of medicine. Dr. Erickson also
serves as an instructor in the Department
of General Practice at the University of
Tennessee Research Center and Hos})ital
and in the National Institutes of ^Mental
Health postgraduate psychiatric pro-
gram at the University of Tennessee.

Class of 1960

Jerrod Norman Lee is engaged in
the practice of pediatric neurology at
the LTniversity of Oklahoma in Okla-
homa City.

Class of 1961

Roger Lee Mehl, surgical resident
at the Presbyterian-St. Luke's Hospital
in Chicago, was the recipient of an
award-winning essav and annual prize
for surgical research from the Chicago
Surgical Society.

Dr. Mehl's work concerned "The Suc-
cessful Treatment of Acidosis and Tox-
emia Following Replantation of an Ex-
tremity Severed for Prolonged Periods."
Dr. Mehl also presented a paper of a
similar title at the meeting of the North
American Chapter of International Car-
diovascular Society in San Francisco in
Tune, 1964.

Vol. 49, No. 3

B. M. C. 1897

William Edward Hamlin i)f \\ al-

tham, Mass., died on l)ecenil)er 15. 1963.
Dr. I lanilin was SS.

B. M. C. 1901

Ralph Gibson Ferry, Sr., of 68

Main St., Wells River, Vt., died Febru-
ary 12, 1964. at the age of 87.

B. M. C. 1903

Herbert Larogue of 10 Cherry Hill
Rd., Reisterstown, Md., died recently.

Class of 1906

William Dick Campbell of 145 W.

Washington St.. llagerstown. Md., died
on December 18. 1963. Dr. Campbell was
89.

B. M. C. 1907

William Fessler of Grantwood. X.
J., died recently.

Ezra Albert Jones of 2263 Elm St.,
Mancliester. X. IL, died recently.

P & S 1907

Jesse Avinette Powell, Edenton,
X. C. died recently.

T. Frederick Leitz, gastroenterolo-
gist and former chief of that department
at Mercy Hospital, died on lanuary 12,
1964. Dr. Leitz was 81.

B. M. C. 1908

Harry C. Podall, 15 K. Jacoby St..
Xorristown, Pa., died on b'ebruarv 17.
1964. Dr. Podall was 81.

P & S 1908

Horace Allen Whisler of 116 Grove
Ave., Clarksburg, W. Va., died on
February 17, 1964. Dr. Whisler was 79.

B. M. C. 1909

Juan S. Morales of 14 Santa Cruz
St.. liavamon, Puerto Rico, died recent-

Class of 1910

Robert Jones Lovill of 125 Rock-
ford St., Mt. Airy. X. C, died recently.

B. M. C. 1910

John Henry Messier of Union
Bridge. Md., died on December 3, 1963.
Dr. Messier was 77.

P & S 1910

Lt. Col. W. Boyd Hunter of Coral
Gables. Fla., died on May 13, 1964.

Class of 1911

Charles Leibold Dries of Barto,
Pa., died September 5. 1963. Dr. Dries
was S2.

P & S 1911

Joseph Birney Kilbourn of Hawk-
hurst Farms died on ^lay 10, 1964, at
the Hartford (Conn.) Hospital.

The son of a member of the P & S
Class 1897, Dr. Joseph Austin Kill)ourn.
he completed his surgical internship at
St. X'incent's Hospital in Xew York City.

\\hile attending a \\'orld Surgical
Congress in London in .August. 1914,
during the time he was studying ad-
vanced surgery at the l^niversity of
X'ienna. England declared war on Ger-
nianw lie returned to offer his services
to the Austrian monarchy. Dr. Kilbourn
was ajjpointed chief surgeon of the Im-

y»/v. 1964

Bi'LLETIX OF THE SCHOOL OF MEDICINE. UXU'ERSITV OF MARYL.iXD

jx'rial Royal Austrian Ambulance Train
and was one of the first to perform mocl-
ern surgery on the battlefields of World
War I. At that time he received an Im-
perial aj^pointment to organize and staff
the ambulance train, financed by the Aus-
train government, the International Red
Cross, and private subscriptions.

For his performance of surgery on
the battlefields of the Russian. Italian.
I^ulgarian, and Carpathian fronts, he
was decorated by the Austrian emperor
and by the Prussian government.

After returning from the war. he
opened an office on Madison Ave.. New
York City, and was assistant visiting
surgeon at Bellevue and German Hospi-
tals and at the Lenox Hill Dispensary.
He returned once again to Austria for
training in Ophthalmology and then re-
turned to the United States, serving on
the staffs of Hartford and McCook Me-
morial Hospitals in Connecticut and at
the Hartford Dispensary. For several
years he contributed his services to the
Glaucoma Clinic of the Hartford Lion's
Club.

During \\'orld War II he was a mem-
ber of the National Draft Board and
President of the Friends of Austria. Inc..
an organization devoted to helping refu-
gees and for the restoration of freedom
in, and the throne of, Austria.

For his refugee work, he was i)erson-
ally cited by Pope Pius XII in 1948.

Dr. Kilbourn was a member of the
.\merican Medical Association, the state,
county, and Hartford ^ledical Societies,
and the Hartford Eye. Ear, and Throat
Society of which he was a past president.

He was a founder of the Eye Clinic
at the Hartford Dispensary, a member
of the Connecticut Historical Society, the
Antiquarian and Landmarks Society.
Sons of the American Revolution, and
the Kilbourn Familv As.sociation.

1 le is survived by his wife, the former
lu'ironess von Gussich. and two sons.

P & S 1912

Harry L. Brillhart of 1036 Talbot
Ave.. Jacksonville. Fla., died December
14. 1963.

Harry Wynn Vinicombe of 1336
Troy Ave., Brooklyn. X. Y.. died re-
cently.

P & S 1914

Frank J. Ayd, Sr., East Baltimore
general practitioner for more than 50
years, died at St. Joseph's Hospital on
March 6. 1964. Dr. Ayd was 77.

A native of Baltimore, he began the
practice of general medicine immediately
after graduation and continued in this
field until 1939. when he limited his
practice to Pediatrics. He was active on
the staff's of the St. Joseph's and Mercy
Hospitals. During World \\'ar II he
served as Assistant to the Director of
the Pediatrics Clinic at University Hos-
pital. For many years he had been active
as a volunteer in youth groups. He
served as attending physician to the old
St. Elizabeth's Home and for many years
was associated with St. Hilary's Indus-
trial School. During this period he do-
nated over 1 .000 volumes of general type
literature to the institution.

Merrill F. Hosmer of 1282 Snell
Isle Blvd.. St. Petersburg. Fla.. died of
leukemia in X'oveml)er. 1963.

Class of 1914

James W. Katzenberger, a general

l)ractitioner in the \\'est Iniltimore area
for nearly a half-century, died on March
5. 1964. '

A native of Oregon. 111.. Dr. Katzen-
berger moved to Baltimore in 1900. He
was active on the staff's of the I*>on Se-
cours and St. Agnes Hospitals.

J'ol. 49, No. 3

ALUMNI ASSOCIATION SECTION

Howard H. Warner, a physician in
Baltimore for more than 40 years, died
June 5, 1964. followinj^ a lengthy illness.
Dr. Warner was 74.

A native of Lincoln. \'a.. he moved to
Baltimore at the age of 12 and was grad-
uated from the Friends School and later
from the I'niversity of Maryland. After
receiving his medical degree, he joined
the 29th Division where he was commis-
sioned as a First Lieutenant. He served
in World War L Following the war, he
resumed practice and for a while was
associated with the late Dr. John Rurah.
well-known ])ediatrician. At that time
he served at the University Hospital in
the Department of Pediatrics and was
also active in the Department of Pedi-
atrics at L'uion Memorial and the W^o-
men's Hospital of Maryland. For a time
he served as a public health officer for
the City of Baltimore.

Class of 1915

Patrick Aloysius Durkin of 73

Maynard St., Pawtucket. K. L, died on
Noveml)er 27, 1963. Dr. Durkin was 73.

Class of 1917

John Thomas Daves of St. Simons
Island, Ga., died on September 17, 1963.
Dr. Daves was 70.

Class of 1921

E. Martinez-Rivera, Apartado 1233.
Hato Key, Puerto Rico, died on March
15, 1964.'

Class of 1924

Samuel Marton of 333 West End
Ave.. Xew ^'ork City, died .August 16,
1961.

W. H. Morrison of 9625 l^-ankford

Ave., Philadelphia, Pa., died on Febru-
ary 6, 1964. Dr. Morrison was 67.

Class of 1927

Hiram Eugene Upton of 144 S.

Willard St., Burlington, Vt., died Janu-
ary IS, 1964. Dr. L'pton was 61.

Class of 1930

Erwin P. Berry of Baltimore, Md.,
died on August 3, 1963. Dr. Berry was

59.

Rollin C. Hudson died on May 29,
1964, after a lengthy illness. Dr. Hudson
was 60.

For many years Dr. Hudson had been
active in medical practice at Towson,
where he had an office at 606 Baltimore
Ave. He also served as a member of the
Board of Managers of the Children's Aid
Society of Baltimore County and had
been active on the staff of the Baltimore
County Health Department, serving as a
specialist in Dermatology.

An avid hobbyist for many years. Dr.
Hudson had collected semi-precious
stones and fossil-marked rocks, acquir-
ing an extensive collection. From some
of these semi-precious stones he fre-
(|uently contrived pieces of jewelry which
he presented to friends as gifts. He was
also a collector of oriental rugs and for
many years raised prize orchids.

Jack Weinstein of 118-02 107th
Ave., Richmond Hill, X. Y., died re-
cently.

Class of 1931

Albert J. Shochat of Baltimore,
Md., died on August 3, 1963. Dr.
.ShoclKit was 57.

Class of 1934

Harry Warshawsky of 523 W. High
St., Lima, Ohio, died February 22, 1964.

July, 1964

HVLLETIX or THE SCHOOL OF MEDICI XE, UXirERSITV OF MARVLAXD

Class of 1935

Robert Lionel DuBois of W atcr-
Iniry, Conn., died on January 1. 1964.
Dr. DuUois was 54.

John Henry Hugg of Jcanncttc.
Pa., died of injuries received in a fall
on October 16, 1963. Dr. Hugg was 56.

Class of 1938

Robert C. Sheppard, surgeon, mem-
ber of the staiY of University Hospital
and chief surgeon at Spring Grove State
Hospital, died suddenly at his home on
April 26, 1964. Death was due to a mas-
sive cerebral hemorrhage.

Dr. Sheppard, who had also been a
member of the medical department of
the \\^estern Electric Co., was a member
of the Bon Secours and St. Agnes Hos-
pitals stafTs.

After serving a two-year internship
at the St. Agnes Hospital, Dr. Sheppard
took a three-year residency in surgerv
at the University Hospital, serving as
its chief resident in his final year. During
A\'orld War H he served in Army field
hospitals in the European theater, re-
turning in 1946 to private practice of
surgery. He w^as a fellow in the Amer-
ican College of Surgeons, a member of
the Medical and Chirurgical Faculty of

Maryland, the American Medical Asso-
ciation, and the American Iioard of Sur-
gery.

l»ol) was a quiet, sincere, and atten-
tive practitioner ; a com])etent surgeon,
friend, and achiser. 1 lis death at the age
of 49. though premature, was but an
untimely conclusion of a career rich in
service and devotion to the highest ideals
of medicine and the practice of surgery.

He is survived by his wife, the former
Nancy Craven, an alumna of the School
of Nursing, University of ^Maryland ;
one daughter, Miss Margaret Sheppard,
also survives.

Class of 1939

Robert T. Coffman of 1 N. Davis
St.. Keyser, W. \'a.. died on April 24,
1964.

Jesse R. Wanner, Jr., of 228 N.
Division St., Salisbury, Md., died Octo-
ber 12, 1963. Dr. ^^"anner was 49.

Class of 1942
Prevost Hubbard, Jr., of 57 Ridge-
way. White Plains, N. Y., died on De-
cember 9, 1963. at the age of 49.

Class of 1944
Jose Garcia y Garcia of 1803 Ponce
de Leon Ave., Santurce, Puerto Rico,
died recently.

Continued from p. xxvi

M.ARTOX, Samuel 1924

AvD, John F., Sr. P&S 1914

DuRKix, Patrick A. 1915

Messler, John H. BMC 1910

Campbell, William Dick 1906

Hamlin, William Edward BMC 1897

Morales, Juan S. BMC 1909

Warshawskv, Harry 1934

Hubbard, Prevost, Jr. 1942

ViNicoMBE, Harry W. P&S 1912

Katzenberger, James W. 1914

Garcia y Garcia, Jose A. 1944

Martinez-Riviera, Ezequiel 1921

DuBois, Robert L. 1935

Sheppard, Robert C. 1938

Coffman, Robert T. 1939

The business meeting then concluded

and was followed by a luncheon in John
Eager Howard Hall.

Scientific sessions then continued from
2 :00 to 4 :00 p.m., followed by a cocktail
party for 50-year graduates at the Lord
Baltimore Hotel.

On the evening of Mav S, honored
guests included the members of the Class
of 1914 (see list of registrants) who were
] (resented with their 50-vear diplomas
and members of the graduating class of
1964. Speaker of the evening was Dr.
jack C. Norris. Assistant Clinical Pro-
fessor of Pathology. Emory I'niversity,
Atlanta, Ga.

Vol. 49, Xo. 3

PLEASE TEAR OUT

ALUMNI NEWS REPORT

TO THE BULLETIN:

I would like to report the following :

SUGGESTIONS FOR NEWS ITEMS

American Board Certification
Change of Address
Change of Office
Residency Appointment
Research Completed
News of Another Alumnus
Academic Appointment
Interesting Historic Photographs

Name

Address

Class

Send to

Bulletin — School of Medicine
University of Maryland
31 S. Greene St.
Baltimore 1, Md.

BULLETIN School of Medicine
University of Maryland

VOLUME 49 OCTOBER, 1964 NUMBER 4

TABLE OF CONTENTS

PAGE

ORIGINAL ARTICLES

Reliability Engineering for Open Heart Surgery — — - 46

William G. Esmond, M.D., R. Adams Coivlcy, M.D.. Albert Lcuntinn, John Francone,
Theodore Carski, Robert Kaestner, Ed'n'ard Hurdle, Bernhard Baker

The Effects of Radiation in Utero On the Human Fetal Brain — _ 56

Marvm A'. Goldstein. MJK, J. A. Wanner, M.D.. and Lester Kiefcr, M.D.

MEDICAL SCHOOL SECTION

Dean's Letter ___. _

New Faculty Appointments and Promotions _

Faculty Notes

Grants _

Proceedings of the University of Maryland Biological Society-
Lecture Series for 1964-65 Announced

Postgraduate Committee Section

Abstracts

Book Reviews _ -

ALUMNI ASSOCIATION SECTION

President's Letter xviii

Alumni Day and Annual Meeting June 3, 1965 Xt

Class of 1915 - - XX

Class Notes _ _ xxlii

October, 1964 45

Relial)ilily Engineering for Open Heart
Snrgery

WILLIAM G. ESMOND, M.D., R. ADAMS COWLEY, M.D., ALBERT LEWITINN, JOHN FRANZONE*,
THEODORE CARSKI**, ROBERT KAESTNERf, EDWARD HURDLEf, BERNARD BAKER t

Introduction

Open heart oi'erations for the re-
pair of complicated congenital and ac-
quired heart defects by trained teams of
physicians have become numerous in
many medical centers throughout the
country. Entry into the heart for the
direct suturing or for the placement of
prosthetic materials requires the occlu-
sion of inflow blood into the heart under
conditions of moderate body hypothermia
(28° C) for a brief period, or the com-
plete support of the patient's gas exchange
and circulation for a prolonged period
with the aid of a heart lung machine. A
tnimber of efficient designs for heart
lung machines are available and in clin-
ical use at the present time. The func-
tion and use of all units is basically sim-
ilar. However, the system developed at
the University of Maryland School of
^ledicine offers significant advantages in
increased reliability.

Briefly, extracorporeal circulation for
open heart surgery is conducted as fol-
lows : After the chest has been opened
l)y the surgical team and the patient's
blood has been treated with heparin,
blood is lead from the patient's great
veins and is allowed to syphon into a
device primed with heparinized blood
designed to permit gas exchange to occur

From the Division of Thoracic Surgery, Department
of Surgery, University of Maryland School of Medi-
cine, Baltimore 1, Maryland.

Supported by U. S. Public Health Grants H-2618
(C8) and H-5636 (C-3).

* Fawn Plastics, Timonium, Md. Baltimore Bio-
logical Laboratories.

** Baltimore Biological Laboratory.

t E. A. Kaestner Co., Baltimore, Maryland.

t Dept. of Mechanical Engineering, The Johns
Hopkins University.

to duplicate the function of the lungs.
This device is called an oxygenator.
Extracorporeal perfusion systems are
basically of three types depending on the
method used to oxygenate the blood.
1 . ) Bubble oxygenation systems function
Ijy injecting oxygen gas directly into a
vertical column of blood. The large sur-
face area produced by the bubbles per-
mits the rapid entrance of oxygen into
the blood and the escape of adequate
quantities of carbon dioxide which leaves
the device by means of a tube provided
for this purpose. The resulting foam pro-
duced by the oxygenating column is rap-
idly broken down by means of silicon
antifoam. 2.) Filming type oxygenation
systems allow gas exchange to occur by
filming large areas of blood on vertical
screens or on rotating discs. 3.) Mem-
brane oxygenation systems consist of
layered envelopes of alternating blood
and oxygen layers in which gas exchange
occurs through permeable membranes of
Teflon® or Silastic® rubber thus avoid-
ing direct contact of blood and oxygen
gas. A rotating disc oxygenation sys-
tem^'^ is employed at the University of
Maryland Hospital in Baltimore (Fig-
ure 1).

Following pressurization in a pump,
warming (or cooling) in a heat exchang-
er, debubbling and filtering, the oxygen-
ated blood is injected into the patient's
femoral artery where it passes into the
main arterial channel of the body, the
aorta, w'here it flows to perfuse all tissues
before returning through the capillaries
to the great veins to complete the cycle

Vol. 49. No. 4

ESMOND. ET AL.-REUABILITV ENGINEERING FOR HEART SURGERY

Fig. 1. Three pump, plastic convoluted disc, extracorporeal circulation system developed at the University

of Maryland.

October. 1964

BULLETIN OF THE SCHOOL OF MEDICLXE, UXIl-ERSITY OF MARYLAND

Fig. 2. Flow circuit diagram used in complete three pump system. Elevated gravity-
reservoir is used to separately perfuse the coronary arteries for aortic root surgery.

(Figure 2). Other circuits must be pro-
vided in the equipment for the gentle re-
covery of blood from the open heart dur-
ing the repair and for perfusing the cor-
onary vessels of the heart itself, if entry
must be made into the aorta near the
heart.

Design Criteria
A large number of design criteria must
be satisfied for a satisfactory safe extra-
corporeal circulatory support system.
The system employed for gas exchange
must permit the discharge of adequate
quantities of carbon dioxide from the
venous blood while at the same time
causing adequate quantities of oxygen
to enter hemoglobin without introducing
actual bubbles into the arterial blood
stream. A means must be provided to
mix an anesthetic gas such as /^%
Halothane® with the 97.5% Oo —2%
CO2 gas at a flow rate of 5 to 10 liters/
minute used to supply the oxygenator.
Sterilization of this gas must be accom-

plished with a Millipore filter membrane
(Figure 2) in order to exclude bacteria
from the oxygenator. All materials used
in the system must be nontoxic and
nonhemolytic to blood. Plastic materials
must be selected with care and, even
though regarded as nontoxic, should not
be employed unless proved nontoxic by
imbedding in rabbit rectus muscle for a
period of two weeks followed by histo-
logic study. All surfaces must be smooth
and be readily cleaned. In order to avoid
propagating serum hepatitis virus, which
is sometimes present in donor blood,
materials must be selected with care so
that they can withstand prolonged im-
mersion in caustic soda solution which
will also dissolve protein films and re-
move pyrogenic materials.

Oxygenators must reliably oxygenate
large quantities of blood at high flow
rates for even the largest adult patients
without damaging blood, and without
causing foaming or the introduction of

Vol. 49, No. 4

ESMOND, ET AL.— RELIABILITY ENGINEERING FOR HEART SURGERY

Fig. 3. Six inch, 13 inch, and 22 inch polycarbonate, autoclavable, reuseable, convoluted disc blood
oxygenators developed for use as the artificial lung for infants, children, and adults.

bubbles of gas into the arterial system
of the patient. Previous experience (prior
to 1958) with stainless steel and glass
oxygenators indicated these units to be
fragile and to sometimes crack during
autoclaving. In addition, glass chips
originating from the ends of the glass
cylinders were sometimes found in as-
sembled oxygenators. Since blood can-
not be allowed to contact bare glass be-
cause of causing coagulation disturb-
ances, glass cylinders had to be coated
with a silicon material for each case. The
removal and recoating of the cylinders
proved to be a major problem and break-
age during handling was frequently
encountered.

It was decided, therefore, to complete-
ly redesign a disc oxygenator in high
impact autoclavable plastic which would
l)e chip-proof, steam autoclavable, rela-
tively low in cost, and which would not
require coating with silicon. The oxy-
genators designed are precision molded
in transparent Lexan polycarbonate
resin® (Figure 3) and can be autoclaved
at 270° F, or sterilized with ethylene
oxide gas. The units are low in cost and,
therefore, can be stockpiled in a sterile
condition ready for instant application

in the event an emergency perfusion is
required. The high impact Lexan plastic
has virtually eliminated problems of
breakage experienced with previously
used glass oxygenators. Injection mold-
ing into highly polished molds has re-
sulted in a mirror smooth finish which
has reduced blood trauma and has elimi-
nated foaming in the oxygenator. The
low thermal conductivity of the plastic
has greatly reduced thermal flux in the
equijDment and the patient's temperature
can be controlled to within 0.1° C if de-
sired. The units are easily disassembled
and cleaned. Precise injection-molded,
replacement, and interchangeable parts
are low in cost.

Bubble traps must be provided to effi-
ciently defoam blood recovered from the
open heart during prolonged procedures.
As much as 50 to 100 liters of blood
must be recycled through this debubbling
system during the replacement of a pros-
thetic heart valve. This blood must be
recovered efficiently and gently and ade-
quately defoamed before returning to the
oxygenator and then to the patient.
Some defoaming systems used for the
recovery of blood from the open heart
by suction discharge the foam directly

October. 1964

BVLLETIX OF THE SCHOOL OF MHDICIXE, UXirERSFrV OF MAR)-LAXD

Fig. 4 Fig. 5

Fig. 4. Polycarbonate open heart suction defoaming reservoir. Fig. 5. Polycarbonate bubble
with 100 mesh electro polished stainless steel screen. Used in the arterial line to the patient as
insurance of bubble free arterialized blood free of potential embolic particles.

trap-filter
the final

over stainless steel sponges coated with
Antifoam "A" (polymethylsiloxane) to
break up the bubbles. Antifoam "A" is
an oily material and can be swept into
the arterial system of the patient to form
embolic particles. We have avoided prob-
lems incident to defoaming by construct-
ing a special reservoir (Figure 4) in
which the open heart suction blood is
injected into a three-chambered compart-
ment where 95 percent or more of the
foaming occurs passively. Excessive suc-
tion for a prolonged period of time
has never involved more than the gentle
contact of the bottom of the coated
sponge with tlie foam. We consider this
method is one explanation for the virtual
absence of neurological problems inci-
dent to open heart surgery at this hospi-
tal. An efficient filter-bubble trap must
also be placed in the arterial line return-
ing to the patient (Figure 5). This unit
must effectively trap small i)latelet
clumps which may occur and is used to

completely debubble the system prior to
the onset of bypass. A 100-mesh electro-
polished stainless steel screen effectively
removes potential embolic material and
is also believed to be responsible for the
A'irtual absence of neurologic problems in
patients following even prolonged periods
of extracorporeal circulation.

Blood pumps must be designed to
handle blood gently with a minimum of
turbulence so as to reduce hemolysis to
a level as low as can be attained. The
pump should have replaceable blood con-
tacting components and be stable in op-
eration for prolonged periods of time.
Pump output should be predictable and
controllal)le in all useful flow ranges. A
single rigidly supported roller, 360°
tubing loop pump, designed at the Na-
tional Institutes of Health was complete-
ly redesigned by the author'^ to provide
a spring-loaded roller floating in four
Thompson linear motion ball bearings"*- ^
to compress the single 360° loop of tub-

Vol. 49, No. 4

ESMOND, HT AL.— RELIABILITY ENGINEERING EOR HEART SURGERY

Fig. 6. Single spring loaded roller, 360' tubing
loop blood developed to minimize hemolysis to the
lowest possible level and to provide precise flow
control as a flow meter. Ten inch disposable stain-
less steel heat exchanger is shown to the left of
the pump.

ing held securely in a redesigned rigidly
mounted cylindrical pump housing (Fig-
ure 6). Six idler ball bearing rollers were
also included to insure the safety of the
tubing loop. Test performance of this
pump fulfilled all desired design criteria.
Accurate flows of from 1 cc to 8,000
cc/minute can be obtained by varying
tube size and rotation rates. Flows up to
32 liters a minute for prolonged periods
of time have been accomplished with a
special high speed drive (0-640 r.p.m.)
without damaging the tubing. Flows of
a fraction of a cubic centimeter per min-
ute may also be accurately delivered
with this pump. Blood hemolysis damage
rates were found to be lower than report-
ed for other blood pumps in use. Re-
cently a new low hemolysis blood pump
designed by the U. S. Army was evalu-
ated at The Walter Reed Army Hospital
with the University of Maryland 360°
single roller spring loaded blood pump.

The Maryland 360° pump was found
equal to the Army blood pvunp at a flow
of 2 liters/min. The Maryland pump
was found less hemolytic than the Army
pump at 4 liters/min. blood flow rate.
Clinical experience with the 360° single
spring-loaded roller pump has shown
very low hemolysis levels and complete
safety in operation. Tubing cannot be
cut or jammed in the pump.

The pump is furthermore unique in
that it serves as a flow meter. The flow
meters are calibrated in two ranges, from
0-4,000 cc/minute and 0 to 8,000 cc/min-
ute. The advantage of being able to set
the required blood flow for each patient
without introducing complex electro-
magnetic flowmeters into the lines can-
not be over-emphasized, and precise flow
control is largely responsible for the
freedom from metabolic acidosis follow-
ing prolonged clinical perfusions, in
otherwise uncomplicated cases. In addi-
tion, the Maryland 360° single spring-
loaded roller pump flow is pulsatile and
produces pulse waves in the patient of
from 10 to 20 mm. of mercury. Pulsatile
flow is desirable and is thought to aid
in proportioning blood to tissues.

Heat exchange is accomplished in the
system by a small 10-inch-long disposable
stainless steel unit (Figure 6) having a
priming volume of less than 100 cc.^
Caloric exchange of as high as 64,000
gram calories a minute can be safely ex-
changed in the unit. A new unit is used
for each case. The units have extremely
low flow resistance, do not hemolize the
blood and have been reliable in opera-
tion. Heat transfer is accomplished by
circulating w-arm or cold water through
the heat exchanger from a wall mounted
Powers' regulator valve or from a supply
of ice water circulated by centrifugal
pumps. Immersion heaters are kept on
hand to produce a supply of emergency
warm water in the event that the hospital

October, 1964

Fig. 8A. Two-hour emergency 110 volt A.C. ni! I i.alUrv p..»er supply sln.un on the right

connected to the complete pmusion system on the left.

ESMOND, ET AL.— RELIABILITY ENGINEERING FOR HEART SURGERY

rS^ fU

' I 1 CUHO I

Fig. 8B. Wiring diagram used in emergency A.C.
power generator.

supply of hot water fails as it did April
14, 1964, due to a short circuit in old
wiring leading to a centrifugal elevated
reservoir supply pump.

The stainless steel cabinets used are
seamless heli-arc welded and highly pol-
ished. The absence of seams allows max-
imum sanitation to be maintained and
heavy gauge construction assures decades
of useful service.

All electrical components have been
selected for maximum reliability and no
failures have occurred in service. The
wiring diagram is shown in Figure 7.
Control boxes are plug-in type for rapid
replacement if required. Three electrical
line power failures occurred at the Uni-
versity hospital about five years ago and
were successfully handled in all cases
with difficulty by manual emergency
cranking. In the fall of 1963 the design
and fabrication of a dynamic 110-volt
2-hour emergency power supplv operated
by nickle-cadmium batteries (Figure 8)
was completed. The sealed lifetime bat-
teries are maintained fully charged at all
times and the loss of normal line power
causes the dynamotor to immediately
switch on with a time delay to full power
of less than one second. Power continues
to flow to the heart lung machine for
2 hours, or until the resum])tion of nor-
mal line power, when relays immediately

OXYGENftTOR
METER
RPM *

0«yqenotor RPM Cohbrotion

oph

lor

US.

'MO

Wilh EmergenCK Power Gen

ero

lor

(Control Bo« on "High")

<^ DESIRED
DISC
y^ ROTATION

10 1 /GEAR /
RATIO/CONTROL^
/line /f /

100 ""E

IN RPM.
^^ PER
^§0 MINUTE

■ ^^

-60

r/zO.\ GEAR RATIO CONTROL

LINE

20 40 60 80 100 120 140

AC. VOLTS

Fig. 9.

Flow Colibrolion Groph (or Use Wilh
2 5 1- Emergency Po»er Generator
jntrol Boxes on "Low"'

A.C. VOLTS
Fig. 10.

transfer connections to normal line
power. Calibration curves have been
carefully prepared (Figures 9, 10, 11)
so that pump and oxygenator output can
be maintained accurately during the
emergency jKjwer period despite a slowly
declining output voltage (Figure 12).

Oclohcr, 1964

BULLETIN OF THE SCHOOL OF MEDICINE, UNU'ERSITV OF MARYLAND

Test of Emergency Nickel -Codmium Bottery
AC Dynomotor Converter Power Supply
for Heart-Lung Machine

AC VOLTS

AC. AMPS X 10-

ARTERIAL PUMP BLOOD FLOW x 10"

D.C VOLTS

DC, AMPS

20 40 60 80 100

TIME IN MINUTES

120

Fig. 12. Despite a declining A.C. output voltage
and frequency, the output of the main arterial
pump and oxygenator can be maintained constant
by applying the previously prepared calibration
curves.

Fig. 13. Instead of an emergency crank, an
emergency torque generator can now be applied to
the main arterial blood pump and oxygenator to
maintain a constant smooth output in an emer-
gency. This unit obsoletes emergency cranks used
in other systems.

Reserve torque in the equipment is high
and sufificient torque remains in the
arterial pump shaft and oxygenator shaft
to maintain full output for the two-hour
period. In addition, two motors and con-
trol boxes are provided in the equipment
to serve in the unlikely event of a motor
failure within the machine itself. In this
rare event, the emergency torque gen-
erator can be quickly attached by means
of flexible shafts to the main arterial
blood pump (Figure 13) and to the oxy-
generator and the flexible shafts will
drive these units indefinitely with a pre-
cision that could not be attained with
manual emergency cranks previously
used. We believe that this is the first unit
of its kind in use for this application. A
reader who read of the Cook County
Hospital blackout for 7y2 hours Febru-
ary 2, 1964, in which all power including
their emergency generators was inter-
rupted, will realize that the optimum
placement of emergency power is at the
exact site of required application. We

believe this unit significantly increases
the security of patients undergoing open
heart surgery with extracorporeal circu-
lation and predict that many systems will
be so equipped in the future.

Equipment is carefully checked and
lubricated periodically. Complete relia-
bility in hundreds of clinical perfusions
has resulted from optimizing design
parameters and from constant vigilance
to insure that equipment is maintained
in the highest state of readiness to serve
the patient.

Summary

Design features for a reliable, low
hemolysis, clinical cardio-pulmonary by-
pass system developed at the University
of Maryland have been presented. A
standby emergency power and torque
generator has been described which in-
creases the security of patients under-
going open heart surgery with the aid of
extracorporeal circulation.

Vol. 49. No. 4

ESMOND. ET AL.— RELIABILITY ENGINEERING FOR HEART SURGERY

Acknowledgements

We wish to tliank the following people for
their valued contributions to this work :

Faivn Plastics Conipcmy, Timoiuitm, Mary-
land: Mr. Floyd Thomas, Mr. William Reese,
Mr. Roy Hcrbst, Mr. Chester Rose, Mr. Bill
Dumler, Mr. Homer Butler.

Wama Plastics Company, BaJtiuiorc. Mary-
land: Mr. William White.

E. A. Kacstiicr Conipa)iy, Baltiintirc, Mary-
land: Mr. Henry Rode, Mr. William Bauer,
Jr., Mr. Norris Gault, Mr. James Wiseman.

University of Maryland School of Medicine,
Baltimore, Maryland: Dr. Andrew Smith, Dr.
Andreas Demetriades, Dr. Safuh Attar, Mrs.
Sarah Moore, Mr. x\vrum Tamres, Mr. The-
odore Brinkman, Mrs. John Mason, Miss Rose-
mary Becker, Miss Ellen Rosenberg.

Baltimore Biological Laboratory, Baltimore,
Maryland: Mr. Raymond BuUinger, Mr. Ber-
nard Dembeck, Dr. Harriet Vera.

Pharmacologic Associates, Timoniiim, Mary-
land: Dr. Harold Bryant.

U)iiz'ersity of Texas, Austin, Texas: Dr.
John Autian, Director, Drug Plastics Testing
Laboratory.

Economy Die and Gasket Company, Balti-
more, Maryland : Mr. George Carr.

Surgical Instruments Manufacturing Com-
pany, Baltimore, Maryland: Mr. Joseph Chyba,
Sr., Mr. Joseph Chyba, Jr., Mr. Dennis Chyba.

Grinding Specialties Company, Baltimore,
Maryland: Mr. Harold Woodward.

Johns Hopkins University, Baltimore, Mary-
land: Dr. Ralph Witt.

Washington Aluminum Company, Baltimore,
Maryland: Mr. Robert Sanford, Mr. William
Campbell, Mr. Kenneth McCauley.

References

1. Esmond, W. G. ; Cowley, A. Adams;
Attar, Safuh; Blair, Emil; Autoclavable
Reusable Plastic Convoluted Disc Oxygena-
tors for Extracorporeal Perfusion Systems.
Am. Surg., 29:586, 1963.

2. Esmond, W. G. ; Cowley, R. Adams:
Single Use Disposable Disc Oxygenator for
Open Heart Surgery, Am. Surg., 24:685, 1958.

3. Esmond, W. G. ; Attar, S. ; Baker, Ber-
nard; Chyba, Joseph; Demetriades, An-
dreas D. ; and Cowley, R. Adams : An Im-
proved 360° Single Roller Spring Loaded
Blood Pump, Trans., Am. Soc. Art. Lit. Org.,
7:1961.

4. U. S. Pat. 2,558,834.

5. U. S. Pat. 2,628,135.

6. Esmond, W. G. ; Attar, S. ; Stram, J. ;
Demetriades, A. D. ; Jurf, Amin ; Gold,
Martin ; Cowley, R. Adams : Profound Hy-
pothermia with Simplified Equipment: A Dis-
posable Stainless Steel Heat Exchanger of
High Efficiency, /. Tlior. and Cardiovas. Surg.,
42:563, 1961.

October, 1964

The Eflfects Of Radiation In Utero On The
Hnnian Fetal Brain*t

Report of a Case

MARVIN N. GOLDSTEIN, M.D.t, J. A. WAGNER, M.D., and LESTER KiEFER, M.D.

Although numerous cases of post-
irradiation damage to the human central
nervous system have been reported;'^' ^
we have been unal)le to find a report of
the effects of irradiation on the central
nervous system of a near-term, human
fetus that lived for an appreciable period
after birth. The following case report is,
therefore, presented.

Case Report: A 1701 Gm. female newborn
was admitted to the nursery of the University
Hospital after birth by low line caesarean
section. The child's mother, para 4-0-0-4 ( STS
negative), and 33 years old, had suffered a
squamous cell carcinoma of the cervix (Stage
I), diagnosed by smear, biopsy and conization.
Exactly five months before the expected date
of delivery, radiation therapy was begun. Two
and one-half months before expected date of
delivery the mother began labor and the child
was delivered by caesarean section. During the
intervening period the fetus received a calcu-
lated 3420-3620 rads of gamma radiation in
fractional doses from Co'^**' and radium.

At birth, the infant breathed and cried spon-
taneously and was thought to be in fine con-
dition, except for mild generalized cyanosis
and tight shiny skin over her fingers. The cir-
cumference of the head was 45.5 cm. ; chest
circumference was 26 cm. ; length was 45.5
cm. Fifteen minutes after birth, the child was
noted to have cutaneous ecchymoses and pete-
chiae, which could be precipitated by slight
pressure to any point on the body. The umbil-
ical cord hemoglobin was 12.2 Gm. The total
blood bilirubin was 3.6 mg.% and the white
blood count was 600.0 per cubic millimeter

* From the Division of Neuropathology, University
of Maryland School of Medicine.

t Aided by a Grant (5 Tl NB 5224-06) from the
United States Public Health Service.

t Present address: University of Chicago Clinics,
Chicago 37, Hlinois.

(66% neutrophils and 34% lymphocytes). Five
hours after birth, edema of all extremities was
noted. At 48 hours of age, the child's hemo-
globin was 10.0 Gm./lOO ml. There were 300
white blood cells per cubic millimeter, 80% of
which were neutrophils with 16%i lymphocytes,
7% eosinophils, and 7% basophils. There were
3000 platelets per cubic millimeter, with 8
nucleated red blood cells per 100 white blood
cells, and a 1% reticulocyte count. At this
time, total blood bilirubin was 22.5 mg. per
100 ml. By the seventh day of life there were
10 nucleated red blood cells per 100 red blood
cells. Reticulocytes numbered 2.4%. The white
blood count, hemoglobin and hematocrit had
steadily dropped.

On the third day of life, epilation had begun
and weakness became marked. Suck, rooting
reflex and Moro reflexes remained active for
7 days. By the 12th day of life, there was no
Moro ; the child would not suck and she was
completely bald. The patient deteriorated pro-
gressively, and expired on the 17th day of life.

General Autopsy Findings

At autopsy, the infant weighed 1500
Gm. There were numerous petechiae and
ecchymoses o\er the body and a de-
creased amount of hair on the scalp. Per-
tinent general autopsy findings were mul-
tiple subserosal hemorrhages over the
stomach and intestines and subpleural
hemorrhages over both lungs. Frothy
fluid was easily expressed from the cut
surface of all lobes of the lung.

Microscopic examination of the bone
marrow revealed almost complete ab-
sence of hematopoietic elements. The
spleen contained only scattered hemato-
poietic cells in the sinusoids, with com-
plete absence of splenic follicles. There

Vol. 49, No. 4

GOLDSTEIN. ET AL.— EFFECTS OF RADIATION ON FETAL BRAIN

iliUliUlllilildrJihijilaiihliiLiiiilhiliJililiiiiil

Fig. 1. Cerebral Convexity: Tlie leptomeninges are
cloudy. The gyri are flattened.

were numerous areas of hemorrhage in
tlie thymus, and most of the cortex was
seen to be made up of fibrous tissue with
only scattered lymphocytic cells. The
liver was remarkable only in that there
was absence of the intramedullary hema-
topoiesis which is normally seen in the
newborn premature infant. The pleura
was thickened and the alveolar walls of
the lungs were seen to be hypercellular.
There were no other significant findings.

Nervous System Findings

Numerous discrete and confluent
hemorrhages were seen under the galea
aponeurotica. Widespread hemorrhagic
foci were present within the epicranium
and dura.

The brain weighed 320 Gm. The ex-
ternal development appeared normal. The

fiiifiiiitiiiiiiiitiimiitmt:
9i ' IJO ' 111 ' 112

ililtiiltlihhlriiithlluldilihliiiih

Fig. 2. Base of the Brain: Notice the confluent
hemorrhages covering the cerebellum.

sulci were widened, and the gyri were
flattened. The leptomeninges showed in-
creased opacity ( Fig. 1 ) . The cerebellum
was covered with a large number of con-
fluent hemorrhages (Fig. 2). The cere-
bellar hemispheres also showed relatively
decreased consistency. The pons and
medulla were of normal appearance and
consistency.

Sections through the cerebrum re-
\ealed poor differentiation between gray
and W'hite matter, considered normal
for this patient's age. Numerous green-
ish petechial hemorrhages were found
scattered through the gray matter (Figs.
3 & 4). The ventricles, hypothalamus
and thalamus were normal. The choroid
plexus of the third and lateral ventricles
contained petechial hemorrhages. Hem-
orrhages were seen in the proximal
medulla and pons. Upon sectioning the

October. 1964

BULLETIN OF THE SCHOOL OF MEDICINE, UNU'ERSITY OF MARYLAND

iiiii|nii|iiii|iiit|iiii|iiiiitif}j!)riiiii(|iiii|iiit|iriipr|Hw^

lilniUhtitiltUlitiiiiiiiltliitliiilthhltiiltintiUiiililtitlilihiiiiltiiii

Fig. 4

Fig.

Fig. 3 & 4. Frontal Sections through the Cerebral

Hemispheres: There are many scattered petechial

hemorrhages in the gray matter.

Jiv, -

0 ' 1 1 ' 12 1,3 ' 1,4 15

|ll!l|ltll|lll!}lli!ji!lli;ill
17 V% lj9

iiiiliiilhihh

liiiiiiiinil

cerebellum, the parenchyma was seen to
be gelatinous and bloody, with many
dilated vessels. Both dentate nuclei ap-
])eared to be disintegrated.

Microscopic

Sections of the spinal cord, stained by
Nissl technique, showed a moderate de-
gree of neuronal chromatolysis and nu-
clear edema. A fresh subdural hemor-
rhage was seen in the sacral region.
Microscopic examination of the cranial
dura revealed intradural hemorrhage
without evidence of inflammatory change.

In all sections of the cerebral cortex,
neuronal swelling and multiple, scattered
petechial hemorrhages were present. In
the right parietal lobe, there appeared to
be loss of normal lamination, a decrease
in the number of neurons with increase
in glial elements ; however, this was the
only area that revealed this change. The
number of neurons appeared within nor-
mal limits (Fig. 5). The occipital lobes
showed increase in glial elements. These
had swollen, very eosinophilic processes,
and which stained well with hematoxylin
showed clasmatodendrosis to Cajal

Vol. 49, No. 4

GOLDSTEIN, ET AL.-EFFECTS OF RADIATION ON FETAL BRAIN

♦/ .vfcr«\ r.^-, • .. "s

/ -•' • * •'• . , * •

~*' }<: , V.V-- '>-'• •-. - '^

L'r?;. «-••',.- ?•<•.-•♦ ' ■' -

Fig. 5. Section of Cerebral Cortex (250x) (H&E):

Note that neurons and laminar structure are within

normal limits.

Cerebellum dOUx): Lcptomeningeal hyper-
plasia is evident.

stains. Similar changes in glial elements
of the deep white matter were seen in the
parietal lobes (Fig. 6). l)Oth centra
semiovale were edematous, with early
swelling of neurons and glia.

The brain stem contained scattered
petechiae. The only other lesion in the
midbrain was a bilateral acidophilic neu-
ronal degeneration of the oculomotor
nuclei, with some increase in glia. There

Fig. 6. Parietal Lobe White Matter (500x) (Cajal

Stain) : The gliae are swollen and increased in

number.

was inflammatory reaction around the
hemorrhages in the peri-peduncular re-
gions of the distal midbrain and in the
pons. Paraventricular neuroglia showed
swelling similar to that described above.
The leptomeninges everywhere appeared
normal as did the intramedullary and
meningeal blood vessels.

Examination of the hypothalamus and
basal ganglia revealed only moderate in-
crease in normal appearing gliae and
swelling of neurons. The most outstand-
ing lesions were found in the cerebellum.

The cerebellar leptomeninges were
moderately hyperplastic (Fig. 7). The
entire cerebellar cortex including the
vermis showed a very thin, acellular and
edematous molecular layer. No evidence
of the external granular layer was found.
Apparently 90^^ of the internal granule
laver was either necrotic or showed swell-

October, 1964

BCLLETIX OF THE SCHOOL OF MEDICIXE, UXU'ERSITY OF MARYLAXD

Fig. 8. Cerebellar Cortex ilOUx)
internal granule layer shows loss of cellular elements
and edema.

rif

^X\y--:f^

Fig. 10. Cerebellar ( ortex (SOOx) (tajal Stain):

Note the edema and increased number of astrocytes

and other glial elements.

ing of cell bodies and cell processes (Fig.
8). The Purkinje cells were seen in nor-
mal numbers, with evident shrinkage of
their cytoplasm, with the nuclei showing
swelling, pyknosis or karyolysis (Fig.
9). Bergmann cells were seen but very
rarely. The matrix was very reticulated
and edematous. The Cajal astrocyte stain
showed a relative increase in the number

Fig. 9. Cerebellar Cortex (500x) (H&E): The

Purkinje cells are in normal quantities, with nuclei

showing degenerative changes.

of astrocytes. All astrocytic elements
were seen to be swollen, apparently in-
creased in number and with very promi-
nent processes (Fig. 10). Fresh petechial
hemorrhages and some layer hemor-
rhages with inflammatory components
were present throughout the cerebellum,
with destruction of scattered areas. The
dentate complexes appeared to be within
normal limits.

Discussion

It has been clinically and experimen-
tally shown that X-radiation exerts a
damaging effect upon bone marrow with
resulting aplastic anemia and hemorrha-
gic diathesis. Epilation is also a recog-
nized symptom of exposure to high doses
of radiation.

Although the notion that the brain is
"radio-resistant" has been widely pro-
nuilgated, this resistance has been shown
to be only a relative one. As early as
1898, French workers demonstrated that
heavy irradiation of small experimental
animals resulted in paralysis and convul-
sions. It was soon discovered that young-

Vol. 49, No. 4

GOLDSTEIN. ET JL.— EFFECTS OF RADIATION ON FETAL BRAIN

er animals were more susceptible than
adults to damage to the central nervous
system.^' ^' ^' "^ Recently Driscoll, ct al..
have reported the findings of two. Ilrst-
trimester human fetuses that were deliv-
ered by uterotomy soon after exposure
to gamma radiation.'^ Although experi-
mental or clinical descriptions of situa-
tions directly comparable to the case pre-
sented above have not been apparently
mentioned, it has been shown repeatedly
in animals and by Driscoll in humans
that the fetal cerebellum is a very radio-
sensitive organ. ^' '^^ After l)rain irradia-
tion, granular layer loss, neuronal and
glial swelling, petechiae, and perivascu-
litis have all been described in both adult
human and experimental animals and in
newborn and fetal experimental animals.
These were, indeed (the perivasculitis
excepted), the very changes found in the
brain of this infant. There seems, there-
fore, to be sufficient evidence to allow
one to conclude that the lesions described
above were due to the intrauterine
exposure to gamma irradiation.

References

1. Bailev, O. T. : Basic Problems in the
Histopathology of Radiation of the Central
Nervous System, In Response of the Nervous
System to loniaing Radiation, T. J. Haley and
R. S. Snider, Editors, New York, Academic
Press, 1962.

2. Brace, K. C. and Alvord, E. C. : X-Ray
Induced Pyknosis of Cerebellar Granule Cells
in Guinea Pigs and Its Suppression by Bar-
liituate Anesthesia, Journal of Neuropathology
and Experimental Neurology, 16:3, 1957.

3. Brunner, H. : Uber den Einfluss der
Roentgenstrahlen auf das Gehirn, Arch. f. klin.
Chir., 114:332, 1920.

4. Campbell, B., Peterson, S. G., and
NovicK, R. : Early Changes Induced in Pur-
kinje Cells of Rabbits by Single Massive Doses
of Roentgen Rays, Proc. Soc. Exp. Biol, and
Med., 61:353, 1946.

5. Clemente, C. D., Yamazaki, J. N., Ben-
nett, L. R., and McFall, R. A. : Brain Radia-
tion in Newborn Rats and Differential Effects
of Increased Age, II Microscopic Observations,
Neurology, 10:669, 1960.

6. Driscoll, S. G., Hicks, S. P., Copen-
HAVER. E. H., and Easterday, C. L. : Acute
Radiation Injury in Two Human Fetuses,
Arch. Path., 76: 113, 1963.

7. Hicks, S. P. : Effects of Ionizing Radia-
tion on the Adult and Embryonic Nervous Sys-
tem, A. Res. Nerv. and Ment. Dis. Proc., 32:
439, 1953.

8. AIoGiLNiTZKv, B. N. and Podjaschuk,
L. D. : Zur Frage fiber die Wirkung der
Rontgenstrahlen auf des zentrale Nerven-
system, Fortscler, Gebretc Rontgenstrahlen,
40:1096, 1929.

9. ScHOLZ, W. and Hsu, Y. K. : Late Dam-
age from Roentgen Irradiation of the Human
Brain, Arch. Neurol. Psych., 40:928, 1938.

10. ScHUMMELFEDER, N. : Sequencc of X-
radiation Damage in Mouse Cerebellum, in
J\esponse of the N^erfous System to Ionizing
Radiation, T. J. Haley and R. S. Snider, Edi-
tors, New York, Academic Press, 1962.

October, 1964

Give to the
school of your choice
through AMEF

American Medical Education Foundation

535 North Dearborn Street
Chicago 10, Illinois

MEDICAL SCHOOL SECTION

Dear Members of the Alumni and Friends of
the Medical School:

The faculty's studies of curriculum and teaching have
continued. As a result of these deliberations, a decision
has been made to allow, in the schedule, free time to be
used by the student to pursue areas of special interest if
the student has the capacity to do so. Definite hours have
been left open in the schedule for this purpose and are
designated as "free time" or "elective time."

There will be faculty guidance and some supervision in
the use of the unscheduled time. However, the student will
be allowed to select the subject to l)e studied, or other use
of free time, depending upon needs and ability of the
student.

It is hoped that these arrangements will increase the
resourcefulness of our students and allow the development
of the individual in medicine with due consideration of
their talents and interests.

Sincerely,

William S. Stone, ]\I.D.
Dean

October, 19(A

New Faculty Appoiiitnieiits and Promotions

Xew facllty appointments and
promotions at the School of ^Medicine
have been recently announced by Dr.
\\'illiam S. Stone, Dean.

Those on the faculty promoted to asso-
ciate professor are Dr. Charles S. Petty.
Dr. Peter Rasmussen, and Dr. M. A\'ilson
Toll in the department of pathology : Dr.
Harold H. Bryant, pharmacology ; Dr.
Ruth \\'. Baldwin. Dr. Raymond L.
Clemmens. Dr. Martin K. Gorten. and
Dr. Gibson J. \\'ells, pediatrics : Dr.
Maureen ]M. Henderson, preventive med-
icine ; Dr. Isadore Tuerk. psychiatry :
and Dr. C. Thomas Flotte, surgery.

X'ew appointments to associate pro-
fessorships on the faculty are Dr. Harle
V. Barrett, department of preventive
medicine and rehabilitation ; Dr. Paul
Fiset, department of microbiology : and
Dr. David G. Simpson, department of
medicine.

Dr. Barrett comes to the University
of Maryland from the post of medical
director for the Creighton University.
Omaha. Nebraska. Formerly serving
with several county health offices in
Kansas and Oklahoma. Dr. Barrett had
been at the Creighton University since
1957. He also served as a captain and
preventive medicine officer with the U. S.
Army for four years in the U. S. and
Korea.

Dr. Paul Fiset was assistant professor
of microbiology and assistant in medi-
cine at the University of Rochester
School of Medicine and Dentistry before
joining the University of Maryland
faculty. He had been associated with the
microbiology department at Laval I'ni-
versity Medical School, Quebec, and is
a former director of Laboratory Services
at Ste. Foy Veterans Hospital, Quebec,
and associate director of microbiolog^■
laboratories at Strong Memorial Hospi-

tal, University of Rochester Medical
Center. Dr. Fiset earned his B.A. from
Laval L'niversity of Cambridge, London.
He served as a major in the Canadian
Officers Training Corps and the Royal
Canadian Army Medical Corps Reserves.
Dr. David G. Simpson has been an
associate in medicine at Columbia Uni-
versity since 1959. A veteran of the
Royal Air Force Medical .Service in
England, India, and the Far East, Dr.
Simpson received his ]\I.D. from Queen's
University in Belfast, Ireland. He is a
former chief resident in chest service at
Bellevue Hospital, Xew York, and
instructor in medicine at Columbia
Universitv.

Dr. Lisansky Named Post-Graduate
Head

Deax William S. Stone has an-
nounced the appointment of Dr. Ephraim
T. Lisansky, Associate Professor of Med-
icine and Assistant Clinical Professor of
Psychiatry in the School of Medicine, as
Chairman of the Committee on post-
graduate studies.

An alumnus of the Johns Hopkins
University, Dr. Lisansky received his
M.D. from the L'niversity of Maryland
in 1933. After an internship and resi-
dency at the Mercy Hospital, he served
for a period in the Department of Pathol-
ogy following which he served with dis-
tinction in the southwest Pacific during
World War II conducting considerable
research in problems of malaria. Follow-
ing his return, he entered the private
practice of medicine and shortly was cer-
tified by the American Board of Internal
Medicine.

Becoming interested in psychiatry, he
devoted a considerable part of his time

Vol. 49, Xo. 4

MEDICAL SCHOOL SECTION

to the study of this speciahy. eventually
qualifying in it and ultimately reaching
the rank of Assistant Clinical Professor
in the Department of Psychiatry special-
izing in psychosomatic medicine. Dr.
Lisansky has had considerahle experi-
ence in post-graduate educational prob-
lems and has been organizer or co-
organizer of many successful programs
designed for practicing physicians includ-
ing general practice and several special-
ties. Dr. Lisansky will assume the office
vacated by Dr. Patrick B. Storey and
will take over his new duties some time
during the month of October. 1964.

Acting Director of University
Hospital Appointed

Dr. \\'illiam S. Stoxe has announced
the appointment of Air. Donald G. Shrop-
shire as Acting Director of the Univer-
sity Hospital following the resignation
of Mr. Lad F. Grapski who moved to
Chicago where he will serve as Director
of Loyola L'niversit}' Hospital.

Dr. Allen Voshell Retires as
Orthopedic Head

Dr. Allex Fiske \^oshell. professor
of orthopedic surgery at the School of
Medicine since 1931, has retired, follow-
ing a distinguished career in his specialty
and in the development of post-graduate
residency and refresher programs both
in general medicine and surger\- and par-
ticularly in orthopedic surgery.

Always active in the cause of the han-
dicapped. Dr. \'oshell was named man
of the year in 1957 by the President's
Committee to Promote Employment of
the Handicapped. That year he was also
recipient of the Baltimore Goodwill In-
dustries annual award of merit. In 1961
he headed the State Planning Commis-

sion subcommittee on chronic illness
whose recommendations led to the estab-
lishment of Maryland's first adult out-
patient rehabilitation centers at the Uni-
versity Hospital and at the Johns Hop-
kins Hospital. He also organized crippled
children's clinics in Ellicott City. Annap-
olis and Frederick County, serving as an
examiner in all three. His service at the
Annapolis and Frederick County clinics
spans more than thirty years.

Dr. \'oshell was active in the organ-
ization and development of post-graduate
educational programs at the L'niversity
of ^Maryland and served as associate
director of the post-graduate committee
under the leadership of the late Dr. How-
ard C. Bubert. At present, he is director
and surgeon in chief at the Kernan Hos-
pital for Crippled Children and is a con-
sultant at the L'nited States Alarine
Hospital. He was former chief consultant
at the Ft. Howard Veterans Hospital
and since 1936 has been a consultant to
the Children's Bureau of the Department
of Labor. He is a past-president of the
American Board of Orthopedic Surgery
and a past-vice-president of the Ameri-
can Academy of Orthopedic Surgeons. In
1941 he received the Academy's gold
medal for his work on knee joints and
the mechanics of ligaments. Dr. \"oshell
will continue his active practice of ortho-
pedic surger}'.

Dr. Sherrer. Former Patholoo^y

Resident. Joints Private Pathology

Group

Dr. Paul F. Gltirix and Dr. Watsox
Kime have announced the association of
Dr. Edward L. Sherrer, Jr., in the prac-
tice of Laboratorv Aledicine. effective
July 1. 1964.

Dr. Sherrer was formerly resident in
pathology at the School of Aledicine.

October, 1964

faculty

NOTES

Department of Anatomy

Vernon E. Krahl, Ph.D., Professor
of Anatomy, has just returned from Sar-
anac Lake, N. Y., where he conducted
several puhnonary studies as a Visiting
Investigator at the new, million-dollar
l)ulnionary research laboratories of the
Trudeau Foundation. As an approach to
the better understanding of control mech-
anisms that operate in the regulation of
mammalian respiration. Dr. Krahl has
been studying the structure, function and
innervation of respiratory apparatus of
lower animal forms such as teleost fishes
and several species of amphibians. A por-
tion of this work, done in collaboration
with Hollis G. Boren, M.D., Director of
the Trudeau Foimdation, w-as reported
in a paper entitled "Ventilatory, Neural
and Other Factors Influencing the Pul-
monary Microcirculation of the Frog."
Dr. Krahl presented the paper in March
at the Third European Microcirculatory
Conference in Jerusalem, Israel. The
meeting was held at the Academy of
Medicine at the invitation of the Capil-
lary Research Laboratory of the Hadas-
sah University Hospital. While in Israel,
Dr. Krahl had an opportunity to visit
several medical and research centers in-
cluding the Academy of Medicine, He-
brew University, Hadassah Medical
Center, Pieilinson Hospital, the Weiz-
mann Institute, and Technion City.

Theodore F. Leveque, Ph.D., Pro-
fessor of Anatomy, and his family sailed
on September 10 for Strasbourg, France,
where they will reside for one year dur-
ing his Sabbatical Leave from the De-
partment of Anatomy. Working with Dr.
Fred Stutinsky in the Institut de Physi-

ologic Cjcnerale of the L'ni\ (.Tsite de
Strasbourg, Dr. Levee jue will continue
liis studies on neurosecretion and hypo-
])hyseo-hypothalamic relationships.

New Appointments

Dr. b^RANK 11. J. l^'icci:. Chairman of
the Department of Anatomy, has an-
nounced the appointment of two new
members to the faculty of his department.

Frederick I. Rams.w, Ph.D., on Sej)-
tember 1, 1964, joined the faculty as an
Assistant Professor of Anatomy. Dr.
Ramsay, a native of P>altimore, received
his B.S. degree at W^ashington and Lee
University where he graduated cum
laitdc, and received his M.S. and Ph.D.
degrees at the LIniversity of Illinois. As
an undergraduate Dr. Ramsay received
a Department Scholarship in Hiologv
and. at Illinois, a Predoctoral Fellowship
of the U. S. Public Health Service. He
taught courses in Gross Anatomy and
Microanatomy at the University of Illi-
nois and, during his service in the Armed
Forces, Dr. Ramsay was assigned to the
U. S. Army Chemical Research and De-
velopment Laboratories at Edge wood,
Maryland. \\Miile at Edgewood he was
also an Assistant, part time, in the
courses of Gross and Microscopic Anat-
omy at the University of Maryland. Dr.
Ramsay's research has included studies
on spontaneous uterine tumors in mice,
the antitumor effects of mouse serum and
the effects of antiserum and adjuvant on
tumor growth. He plans further studies
on tumor growth, using tissue culture
techniques. Dr. and Mrs. Ramsay and
their three children are residing in Luth-
erville, Md.

Gladys E. Wadsworth, Ph.D., has
l)een appointed Assistant Professor of
Anatomy, effective October 1, 1964. Dr.
Wadsworth received her P).S. degree at
State Teachers College at Stroudsl)urg,
Pa., and her M.A. degree at Teachers

Vol. 49, No. 4

MEDICAL SCHOOL SECTION

College at Columbia University in New
York. After receiving her certificate in
Physical Therapy at Walter Reed Hos-
pital in Washington, D. C, Dr. Wads-
worth served as Chief Physical Therapist
at the U. S. General Army Hospital at
Battle Creek, Michigan, and later, at
Georgetown University Hospital in
Washington, D. C. While completing her
work for her Ph.D. degree at the Uni-
versity of Maryland under the direction
of Dr. Eduard Uhlenhuth (who was, at
that time. Chairman of the Department
of Anatomy ) . Dr. Wadsworth was an
Instructor in Anatomy. From 1956 to
1962 Dr. Wadsworth directed the De-
partment of Physical Therapy at the
University of Maryland, then for two
years served as a consultant in the Divi-
sion of Education of the American Physi-
cal Therapy Association in New York
City. Dr. Wadsworth's research interests
have been in the areas of body mechan-
ics and in the anatomy of the pelvis ; she
is co-author of a paper on the latter sul)-
ject with the late Dr. Eduard Uhlenhuth.
She is a member of several professional
societies, including the American Asso-
ciation of Anatomists and the American
Physical Therapy Association.

Dr. Spicer Speaks at Symposium

Dr. William Spicer, Associate Pro-
fessor of Medicine, was among the speak-
ers at the Symposium on Environmental
Health Hazards sponsored by the Mary-
land Academy of Sciences and held on
October 17 at Goucher College. Dr.
Spicer spoke on "Air Pollution."

Dr. Kent E. Robinson Honored

Dr. Kknt E. RoBixsox. Associate in
Psychiatry at the School of Medicine,
has been named Director of Out- Patient
Services at the Sheppard and Enoch
Pratt Hospital. Towson, Maryland.

Dr. Helrich Speaks at International
Meeting

Dr. Martin Helrich, professor and
head of the Department of Anesthesiol-
ogy at the School of Medicine, partici-
])ated in the Eighth Scandinavian Con-
gress of Anesthesiologists held in Turku,
Mnland, on August 6th. Dr. Helrich pre-
sented a paper entitled "Circulatory
Compensation Following Analgesic
Drugs in Man."

Faculty Participate in General
Practice Scientific Assembly

Members of the Faculty of the
School of Medicine were active on the
program of the Annual Scientific Ses-
sions of the Maryland Academy of Gen-
eral Practice held at the Southern Hotel
October 17 and 18, 1964.

Dr. Harlan I. Firminger, Professor
and Head of the Department of Pathol-
ogy, presented a panel discussion on
"Visible Tumors and Tumor-like Lesions
of Interest to the General Practitioner."
Associated with Dr. Firminger were Dr.
Robert G. Chambers who spoke on "Vis-
ible Tumors and Tumor-like Lesions of
the Head and Neck." Lesions of the Oral
Cavity were discussed by Dr. Cyrus L.
Blanchard, Professor of Otolaryngology.
Dr. Raymond C. Vail Robinson spoke
on "Visible Tumors and Tumor-like
Lesions of the Skin" and Dr. Richard S.
Munford, Associate Professor of Gyne-
cology, spoke on "Similar Lesions of the
Vulva and Vagina." Dr. Robert W.
Buxton, Professor of Surgery, discussed
"Visible Tumors and Tumor-like Les-
ions on the Anus and Rectum."

The afternoon session was highlighted
l)y a panel entitled "The Initial Interview
and Its Significance" led by Dr. Leo tl.
Bartemeier, Clinical Professor of Psy-
chiatry at the School of Medicine, assist-
ed by Drs. Ephraim T. Lisansky and
Bernard R. Shochet.

October, 1964

BULLET IX OF THE SCHOOL OF MEDICIXE, UXWERSFTV OF MARY LAX D

GRANTS

Dr. Frank H. J. Figge, chairman of
the Department of Anatomy, has received
a grant of $990.00 from the Bressler Re-
serve Fund to aid his development of
cinematographic techniques for use in
medical education and research.

The American Cancer Society has
awarded a grant of $7,500.00 to Dr. Figge
in support of his studies on the activity
or augmenting influence of mammary
tumor agent virus on leukemogenesis in
the C3HFg mouse.

The U. S. Army Research and Devel-
opment Command has awarded a contract
in the amount of $30,000 to the Depart-
ment of Anatomy for a continuing re-
search program on comparative neuro-
anatomy. The program is under the
direction of Dr. Frank H. J. Figge.
Collaborating in these studies are Ford
Ebner, D.V.AI., who is a Special Fellow
in the Department of Anatomy, and
Sven Ebbeson, Ph.D., Instructor in
Anatomy, part time.

Dr. Charles Crispens, Assistant
Professor of Anatomy, has received from
the American Cancer Society a grant of
$1,900 for one year in support of his
studies on a virus that produces bio-
cliemical lesions in mice.

Dr. Joseph Wells, Assistant Pro-
fessor of Anatomy, has received a re-
search grant in the amount of $45,021
from the National Institutes of Health
of the U. S. Public Health Service. The
grant, covering a three-year period, will
support Dr. Wells' studies on the func-
tional relationships of the Nucleus
Dorsomedialis.

Dr. Verxon E. Krahl, Professor of
Anatomy, and a recent recipient of a

Career Research Award from the Na-
tional Institutes of Health of the U. S.
Public Health Service, has received a
research grant from the same agency, in
support of his studies on the finer struc-
ture of the mammalian lung. Now in its
ninth consecutive year. Dr. Krahl's cur-
rent grant has been extended an addi-
tional four years with financial support
totaling nearly $45,000.

Computer Center Progresses

Dr. George Entwisle, Director of the
Health Sciences Computer Center, has
announced that significant progress has
taken place with respect to the develop-
ment of the Computer Center to be lo-
cated in the Howard Hall of the School
of Medicine. Architectural drawings are
being prepared and it is anticipated that
the facility will be available in 1965. In
the meanwhile, Mr. Robert L. Jones,
currently Systems Engineer with the
International Business Machines Corpo-
ration in Syracuse, has been named Man-
ager of the Computer Center. Until such
time as the area is renovated and the
equipment installed, Mr. Jones wall work
in collaboration with the established com-
munication center at College Park.

Proceedings of the University of

Maryland Biological Society to be

Published by the Bulletin

Herewith we again begin the reg-
ular publication of the proceedings of
the University of Maryland Biological
Society. For many years the Bulletin
regularly carried these proceedings and
abstracts. It is again a pleasure to rein-
stitute this regular feature.

Vol 49, No. 4

Proceedings of the
University of Maryland Biological Society

November 26, 1963. Room 376, Howard Hall.

"The Lactic Dehydrogenase Agent : Its
Possible Implications for the Virologist
and the Oncologist." Charles G. Crispens,
Jr., Ph.D., Department of Anatomy, School
of Aledicine.

Abstract

The lactic dehydrogenase (LDH) agent
was first reported by Riley ct al. ( Science,
132:544, 1960) who observed a 5- to 10-
fold increase in the plasma LDH activity
of test animals 48 hours after inoculation
with tissue or organ extracts from mice
bearing a variety of transplanted tumors.
In this laboratory, studies were initiated
to investigate the nature of the LDH agent
and its relationship to murine tumorigene-
sis. Mice bearing 2 transplantable tumors
(C57BRT or C1300) \vere observed to
contain the agent ; no evidence was found
of its association with 4 human neoplasms.

The LDH agent is transmitted readily
between mice in the same cage, but not
between animals in different cages. It is
excreted in saliva and urine at 36 hours,
but not 5 weeks, after infection. In feces, it
is excreted up to 15 weeks after infection,
presumably until death. Preliminary find-
ings suggest that the LDH agent is trans-
mitted /;; iifcro and in the milk of lactating
females.

Recent studies indicate that the LDH
agent is both ether and sodium desoxycho-
late-sensitive. It is stable after storage for
6 months at — 20 °C., and inactivated by
heating at 56 °C. for 30 minutes. Heat in-
activation is enhanced by Mg ions. Com-
plete inactivation of the LDH agent is
found after 300 minutes of ultraviolet irra-
diation or 48 hours treatment with forma-
lin. There is a region of relative stabilitv
from pH 4.0 to 10.0.

Thin sections of pellets prepared from
infected plasma show oval-shaped particles
which measure 15 m/* x 45 nii^.. The im-
l)lications of these findings and results ob-
tained in other laboratories are discussed.

December 17, 1963. Room 376, Howard Hall.

"Voltage Clamp Studies on the Effect of
Internal Sodium and Potassium on Inter-
nally Perfused Squid Axons." William J.
Adelman, Jr., Ph.D., Department of Physi-
ology, School of Medicine.

Abstract

Cleaned, isolated giant axons were
perfused internally witii solutions contain-
ing a variety of potassium and sodium ion
activities. Solutions were made isosmotic
by sucrose addition. The resting potential
could be approximated closely by the fol-
lowing relation :

En, = (RT/F) log l(a„^ + OMa^J

I (aj,; + 0.25a,., ^^^l

when internal potassium sulfate and phos-
pate and external sodium and potassium
chloride solutions were used. When the
internal and external K+ concentrations
were equal at 10 niM, the steady state (K)
current in the voltage clamp was zero
upon making an appropriate leakage cur-
rent correction. Similarly, when the inter-
nal Na+ concentration was zero, no out-
ward initial membrane current was meas-
ured upon voltage clamping. The sodium
])otential, measured as the clamped voltage
at which the initial membrane current turns
from inward to outward, was found to vary
with the internal and external sodium ion
activity. A close agreement w^as obtained
between sodium potential values and theo-
retical thermodynamic sodium equilibrium
potential values. Upon low K internal per-
fusion, the steady state curve of inactiva-
tion of sodium conductance vs. membrane
voltage was ciianged in slope and moved
in the direction of depolarization yielding
considerable activation at low membrane
potentials. Undamped, these low internal
K axons were excitable with short de-
polarizing currents and gave almost normal
amplitude action potentials despite low-
resting potentials.

January 23, 1964. Room 376, Howard Hall.

"Mechanisms of Tolerance to Endotoxin
in Man." Sheldon E. Greisman, M.D., De-
partments of Medicine and Physiology,
School of Medicine.

February 26, 1964. Room 377, Howard Hall.

"Field Studies in West Pakistan." Robert
Traub, Ph.D., Department of Microbi-
ology, School of Medicine.

April 1, 1964. Room 377, Howard Hall.

1. "Inter-relationship Between the Meta-
bolism and Meciianism of Action of

October, 1964

BULLETIX OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Nitroglycerin." Philip M. Needleman,
Fellow, Department of Pharmacology,
School of Medicine.

2. "Experimental Infection of Murine
Typhus in the Guinea Pig." Ychia El
Batawi, M.D., Department of Micro-
biology, School of Medicine. (See Ab-
stract)

3. "A Comparative Study of the Convulsant
Bis (2, 2, 2 Trifluoroethyl) Ether and
Its Analog Bis (2, 2, 2 Trifluoroethyl)
Thioether." Robert S. Rozman, Ph.D.,
and Raymond AI. Burgison, Ph.D., De-
partment of Pharmacology, School of
Medicine.

4. "Nature of the Binding between DNA
and Protein in Deoxyribonucleoprotein."
Stephan A. Lesko, Jr., Fellow, Depart-
ment of Biochemistry, School of Medi-

Abstract

DNA is always found associated with
histones and residual protein in mammalian
tissues. The residual protein appears to be
bound firmly to the DNA since exhaus-
tive treatment of deoxyribonucleoprotein

with ice-cold 0.2 N IICl or 1 M NaCl,
pH 3, followed by a subsequent treatment
with detergent will not remove all of this
protein. To study the nature of this bind-
ing, DNA was digested with DNase I
alone or in combination with snake venom
phosphodiesterase. The digest was frac-
tionated on paper by higli voltage electro-
])horesis using 0.1 AI acetate buffer, pH
3.6. Tiie U. v. absorbing nucleotide frac-
tions were eluted and hydrolyzed with 6 N
HCl at 110°C. for 18 hrs. Thin layer
chromatography of the hydrolysates re-
vealed several ninhydrin spots indicating
the i)resence of peptide or i)rotein material
in the nucleotide fractions. At pH 3.6, most
peptides and proteins would be e.xpected
to carry a zero or net positive charge,
while the nucleotides or polynucleotides
would carry net negative charges. Peptide
or protein material found in the nucleotide
areas must therefore be firmly bound to
the negatively charged nucleotides. It is
concluded that residual protein is firmly
bound to DNA, perhaps through a covalent
bond. ( Supported by USPHS Grant No.
GM 05874-06.)

May 12, 1964. Castle Motor Inn, Baltimore.

"Pesticides, Fish, and Wildlife." John L.
Buckley, Ph.D., Chief, Office of Pesticides
Coordination, United States Department of
Interior.

Vol. 49, No. 4

Lecture Series For 1964-65 Announced

The following special lectures
have been scheduled for the School of
Medicme beginning with the November
10th Julius Friedenwald Memorial Lec-
ture. Two lectures have already been pre-
sented, one by Dr. Paul Havens, Pro-
fessor of Medicine and Microbiology at
the Jefferson Medical College, who spoke
on "Diagnosis of Complicated Liver Dis-
orders."

The annual Phi Delta Epsilon lec-
ture was presented by Dr. Allen R. Fein-
stein. Associate Professor of Medicine at
the Yale University School of Medicine,
who spoke on the "Changing Clinical
Concepts in Rheumatic Fever."

The Julius Friedenwald Memorial

Lecture will be held on Tuesday, No-
vember 10, 1964, at 11 :30 a.m. in Gordon
AMlson Hall by Joseph B. Kirsner, M.D.,
Professor of Medicine and Head of the
Division of Gastroenterology at the Uni-
versity of Chicago School of Medicine,
who will speak on "The Approach to
Functional Disorders of the Gastrointes-
tinal Tract."

The Eighth Pincoffs Lecture is

scheduled for Monday, December 7,
1964, at 8:15 p.m., in Davidge Hall and
will be presented by Arnold S. Relman,
j\I.D., Professor of Medicine at Boston
L'niversity School of Medicine and Chief
of the Renal and Metabolic Division of
Massachusetts Memorial Hospitals, who
will speak on "Some Xew Ideas about
Acid-Base Regulation : Clinical and
Physiological Considerations."

A. B. Baker, M.D., Professor of
Neurology at the University of Minne-
sota School of Medicine, will discuss
"Pathogenesis of Cerebrovascular Dis-
ease" on Tuesday, January 19, 1965, at
11 :30 A.M. in Gordon Wilson Hall.

Harry A. Feldman, M.D., Chair-
man, Department of Preventive Medicine
of the Upstate Medical Center of the
State University of New York, will dis-
cuss "Toxoplasmosis : Clinical Manifes-
tations, Diagnosis and Management" on
Tuesday, February 23, 1965, at 11:30
A.M. in Gordon \\'ilson Hall.

Thomas McP. Brown, M.D., Eugene
Meyer Professor and Chairman, Depart-
ment of Medicine of the George Wash-
ington LTniversity School of Medicine,
will discuss "Pathogenesis of the Rheu-
matic Disorders" on Tuesday, Alarch 16,
1965, at 11 :30 a.m. in Gordon A\'ilson
Hall.

The Uhlenhuth Memorial Lecture,

sponsored by Phi Beta Pi Fraternity,
will be held on Tuesday, April 13, 1965,
at 11 :30 a.m. in Gordon Wilson Hall and
will be presented by Barton Childs, M.D.,
Professor of Pediatrics at Johns Hopkins
School of Medicine, who will speak on
"Genetic Control of Disease."

Lawrence E. Hinkle, Jr., M.D.,

Associate Professor of ^Medicine in Psy-
chiatry and Director of Division of Hu-
man Ecology of Cornell L'niversity ^Vled-
ical College, will discuss "The Ecology
of Human Illness and Health" on Tues-
day. May 11, 1965. at 11:30 a.m. in
Gordon ^^'ilson Hall.

October. 1964

POSTGRADUATE COIMIVIITTEE SECTION

MRS. ELIZABETH B. CARROLL, Exccutizr Secretary

Postgraduate Office : Room 201

Davidge Hall, 522 West Lombard Street, Baltimore, Maryland 21201

Postgraduate Courses for the 1964-1965
Academic Year

The following courses are scheduled
to be given during the current academic
year. Complete information may be ob-
tained from the office of the Postgradu-
ate Committee. School of Medicine, Uni-
versity of ^Maryland, Baltimore, Mary-
land. 21201.

Hughesville Course

To be given on eight consecutive
Wednesdays beginning on September
16, 1964, at the Auditorium of the
Southern Maryland Electrical Co-op in
Hughesville, Charles County, Maryland,
from 6:00 p.m. to 8:00 p.m. Tuition
fee $25.00.

Anesthesia Day

November 5, 1964, under the direction
of Dr. IVIartin Helrich and Dr. Martin
I. Gold. Designed for physicians and sur-
geons who are concerned to any extent
with the administration of anesthesia, or
who must, from time to time, be involved
with problems incident to that field. To
be given on the campus of the medical
school in Baltimore. Tuition fee $15.00.

Eye, Ear, Nose & Throat

December 3, 1964, under the direction
of Dr. Cyrus L. Blanchard and Dr. Rich-
ard D. Richards. The practical problems
of ophthalmology and otolaryngology
with which the practicing physician must
be conversant will be presented. To be

given on the Baltimore campus. Tuition
$15.00.

Neuropathology for Pathologists

Under the direction of Dr. John A.
Wagner, this course w^ill be full time
from December 7 through December 12,
1964. Given at the practical level and in-
cluding basic neuropathology, traiuna,
tumors, infections and degenerative dis-
eases ; surgical neuropathology ; the neu-
rological clinico-pathological conference ;
and practical drill in cutting, blocking,
staining, and microscopic study of pro-
vided specimens. This course is limited
to certified pathologists or those eligible
for certification, and because of the indi-
vidual attention given to each student
only 12 applicants can be accommodated.
To be given on the Baltimore campus.
Tuition $125.00.

Surgical Physiology

To be given on December 17, 1964,
under the direction of Dr. Arlie R.
Mansberger, Jr. The course will be con-
cerned with pre-operative and post-op-
erative physiology, functional derange-
ments, and management of the clinical
problems commonly presented by the
surgical patient. Tuition $15.00. To be
given on the Baltimore campus.

Advances in Medical Science

To be given on Wednesdays from 3 :00
to 5 :00 P.M., beginning on January 13
and ending on March 31, 1965. The

Vol. 49, No. 4

MEDICAL SCHOOL SECTION

course is designed for physicians who
wish to review the important advances
in medical science. Emphasis is placed
on a basic scientific approach to an un-
derstanding of the more common clinical
problems and their management. To be
given on the Baltimore campus. Tuition
fee $40.00.

Dermatology Day

To be given under the direction of Dr.
Harry M. Robinson. Jr., on January 21,
1965. This will be a clinical session in
which many dermatologic disorders will
be seen and examined by the attending
physicians, followed by presentation and
discussion of the problems of diagnosis
and management of each entity. To be
given on the Baltimore campus. Tuition
fee $15.00.

Clinical Anatomy

To be given under the direction of Dr.
Otto C. Brantigan one morning and one
afternoon each week beginning with the
second semester of the medical school.
The course emphasizes the practical ap-
plication of anatomy and anatomical
principles in physical and x-ray diag-
nosis. Anatomical knowledge is related
to the use of needling in performing diag-
nostic procedures and in treatment. The
course is directed toward both the med-

ical man and the surgeon. Tuition fee
$150.00.

Clinical Cardiology

February 4, 1965, under the direction
of Dr. Leonard Scherlis. Designed to
present to the practicing physician some
of the advances in our diagnostic meth-
ods and management of the more com-
mon clinical problems in cardiology. To
be given on the Baltimore campus. Tui-
tion fee $15.00.

Gynecology Day

February 11, 1965, under the direction
of Dr. Edmund B. Middleton. Considera-
tion will be given to the practical prob-
lems encountered in the office and clinic
care of the gynecologic patient. To be
given on the Baltimore campus. Tuition
fee $15.00.

Hematology Day

March 11, 1965, under the direction
of Dr. Milton S. Sacks. The course will
afford a basic review of diseases of the
hematopoietic system. Illustrative peri-
pheral blood and bone marrow slides will
be utilized in connection with selected
case material. Newer techniques of diag-
nosis and treatment will be discussed. To
be given on the Baltimore campus. Tui-
tion fee $15.00.

October, 1964

ABSTRACTS

of arficles by
faculty and alumni

Iron Metabolism in Premature Infants —

Martin K. Gorten and Eleanor R. Cross.
/. Pcdiaf. . 6i:509, 1964.

The results of this study indicate clearly
that iron fortification of an infant formula,
offered to premature infants from the newborn
period, affords effective prophylaxis against
iron deficiency. Acquisition of hemoglobin iron
keeps pace with the rapid growth of these
infants. Hematologic observations from the
tenth week of life are indistinguishable from
those of healthy term infants receiving optimal
nutritional care. On the other hand, the
majority of premature infants who derive iron
solely from iron-fortified and iron-containing
solid foods, even when these foods are fed from
an early age, develop true iron deficiency ane-
mia. This nutritional anemia can be corrected
effectively by the addition to the diet of a
formula containing 12 mg. of elemental iron
per quart.

William Alexander Hammond— 1828-1900
(Special Communication) — Albert F.
Heck.

JAMA, 466, 1963

This is an illuminating concise study of an
important physician of the mid 19th century,
a former professor at the School of Medicine,
who became Surgeon General of the Grand
Army of the Republic, through whose fore-
sight and determined energy the medical ser-
vices of the army were completely revised
with certain principles still applicable today.

While earning for himself a lasting degree of
importance and immorality, he was court-
martialed, dismissed from the army before the
end of the war, only to return as a practitioner
of neurology and founder of the Neurological
Association. Later in his life his dismissal was
vindicated by Acts of Congress in 1878. Ham-
mond was not only prophetic but was an
author of considerable repute, having published
a textbook of neurology which went through
seven editions in ten years. He founded the
Armed Forces Institute of Pathology and
directed the publication of the Medical and
Surgical History of the War of the Rebellion.

Retinal Involvement in Adult Cytomegalic
Inclusion Disease — Morton E. Smith,*
M.D.
A.M.A. Arch. Ophthal. (July, p. 44) 1964

Cytomegalic inclusion disease is rarely en-
countered in the adult. Of 54 cases in the
literature, none contained histologic evidence
of the disease in the eyes. A case of the disease
in a 61 -year-old Negro woman with the char-
acteristic inclusion-bearing giant cells found in
the retinas of both eyes is described.

The importance of recognizing this disease
in debilitated patients who have been on long-
term treatment with various drugs is stressed.
Eighty pairs of eyes from patients in this cate-
gory who came to autopsy were reviewed, but
cytomegalic inclusion bodies could not be
demonstrated.

* Ophthalmic Pathology Branch, Armed Forces In-
stitute of Pathology, Washington, D. C. 20025.

f ■«/. 49, No. 4

liook 3^ebieb3SJ

The Cytologic Diagnosis of Cancer. 2nd Ed.

Ruth AI. Grahm. Zll pp. Illus. W. B.
Saunders Company, Philadelphia and Lon-
don. 1963.
The first edition of Mrs. Grahm's book, al-
though published in 1950 when cytology was
in its early stages, has continued to be a val-
uable book in the training of technical person-
nel and as a guide to residents in pathology.
This new edition has been considerably ex-
panded and some sections, where new knowl-
edge has become available, have been rewrit-
ten. The basic purpose of the book, to guide
the student of the subject in the interpretation
of cellular morphology, has remained un-
changed. Many of the photographs and plates
from the first edition have been reused and
many new illustrations have been added. The
quality and clarity of the illustrations is uni-
formly excellent. The chapters which have
been added bring the book up to date and
discuss several difficult and controversial areas.
Postradiation smears, both positive and nega-
tive, are thoroughly discussed. Separate chap-
ters have been added on dysplasia in cervical
smears, the cytology of carcinoma of the
esophagus, the cytology of material aspirated
from solid masses, and a short chapter on
cellular changes in pernicious anemia is in-
cluded. The latter chapter seems to predict
more and more application of the technique
to the diagnosis of non-malignant conditions.
There is no chapter on fluorescent cytology but
this is not a great omission. The text also
lacks a general discussion of the pathogenesis
of the conditions discussed. The addition of
such a discussion would, however, expand the
volume to an unusable size and this aspect of
the subject of neoplasia is much better covered
in textbooks of pathology. The references are
well chosen and extensive.

The text should become a standard in the
training of cytological technicians as was the
first edition. It will also be of great value to
residents in pathology.

H0W.\RD M. WiSOTZKEY, M.D.

October, 1964

A Handbook for Ambulance Room Attend-
ants by C. E. Watson. Pp. 120. The
Williams and Wilkins Co., Baltimore. 1961.
$1.95.

This is a short, well written first aid manual
directed primarily to the layman working in
an industrial first aid station. Included are
simple instructions for the treatment of injuries
and infections. There are appendices describing
the more useful dressings, with a short, clearly
written glossary of medical terms. The index
is adequate. A simple guide to the assessment
of the severity of illness is one of the unique
chapters in this book.

This volume is a good introduction to mod-
ern first aid practices for the industrial clinic
attendant.

Marvin N. Goldstein.

Case Studies in Obstetrics and Gynecology

by F. Jackson Stoddard, M.D. Pp. 298. W.
B. Saunders Co., Philadelphia, Pa. 1964.
$8.50.

Dr. Stoddard states in his preface that this
book "is designed to complement and make
more meaningful his (the student's) earher
formal training and experience." To achieve
this end, the author has selected 60 case his-
tories that illustrate well the commoner patho-
logic entities one encounters in the field of
Obstetrics and Gynecology. Each case is dis-
cussed from the point of view of differential
diagnosis and treatment ; a simulated question
and answer exchange follows ; then a follow up
of management is presented, if appropriate.

The cases are very well selected, because
the author has resisted the temptation to re-
count the bizarre example. Instead he presents
the typical case, which makes it more mean-
ingful to the reader. Although only 60 subjects
are formally presented, a much broader range
of to])ics is covered through the discussion and
c|uestion and answer selections of the book.

The case histories themselves are well edited,
with emphasis on the important points. The

BVLLEriX OF THE SCHOOL OF MFDICIXF. rXirFR'SITV OF MARYLAND

stock plirases that one hears so coniiuonly at
conferences as part of such presentations arc
noticeably absent.

In discussing the diflcrontial diagnosis and
therapy, the author is logical in the fornur and
conventional in the latter. His management re-
flects what is good practice everywhere. Some
unusual methods of management that are
regional are recounted through the question
and answer sections for completeness.

Illustrations and tables are appropriate and
are certainly easy to follow. The layout of the
text makes for effortless reading.

The references listed at the end of each case
are highly selected, but intentionally so. They
are key articles or reviews that can be used
as points of entry into any esoteric area that
might strike the individual reader.

This text could be useful to anyone with a
basic knowledge of the field. For the advanced
student it would help consolidate many seem-
ingly disconnected facts into a memorable
disease entity. For the non-specialist it could
keep him alert to the unusual in the framework
of his own practice. For the specialist it affords
a quick review and handy reference to many
processes that are rare even in highly selected
populations.

This book is therefore iiiglily rocominended.

James P. Durkan, M.D.

Physiologic Principles of Surgery edited by
Leo M. Zimmerman and Rachmiel Levine.
Pp. 988. W. B. Saunders Co., Philadelphia,
Pa. 1964. $20.00.

This is the second edition of a rather unique
book, which very successfully fills a great void
in the surgical literature. The modern surgeon
must strive for a greater understanding of nor-
mal human physiology and the changes brought
about by injury, disease, anesthesia, and opera-
tion. This book offers a concise and critical
appraisal of practical surgical physiology by
50 eminent surgeons and physiologists.

The first 13 chapters deal with such topics
as the metabolic changes associated with in-
jury, infections and antibiotics, tissue trans-
plantation, shock, and nutrition. A new chapter
has been added on oncology. The remaining
24 chapters are arranged by organ system. All
chapters are current and well written, but vary
considerabl)' in detail and subject treatment.
The book is quite readable with numerous help-
ful illustrations, tables, and graphs. The index

is excellent. The bibliography varies from
chapter to chapter but is generally complete.

This fine book is heartily recommended to
students, and a well worn copy should be in
every surgeon's library.

Carl F. Berxer, M.D.

Outline of Medical Parasitology by John E.
Larsh. Pp. 342. McGraw-Hill Book Co.,
New York, N. Y. 1964. $6.95.

In the past few decades the lujrizon in tlie
concept of i)arasitic diseases has widened be-
yond most i)hysicians' expectations. One may
reasonably estimate that even in tlie United
States, 50 million citizens harbor parasites at
the present time. Many physicians serving in
tiie United States Armed Services have en-
countered what were previously considered
exotic diseases and have had to review the
parasitology learned in the second year of
medical school. Indeed, with the "cold war,"
World Health Organization activities, private
industry expansion into foreign lands, and the
astounding ease of world travel, the physicians
in this country are faced witii tlie problem of
recognizing and treating parasitic infections
l)reviously considered rare and unimportant
curiosities. With this background, the teaching
of parasitology in medical schools has taken on
a greater import. It is also recognized that
medical schools are faced with ever increasing
subject matters to teach to the medical students
within a relatively short period of four years.
This book by Dr. Larsh reflects the experience
of 20 years in teaching this subject to medical
students and admirably succeeds in the purpose
stated in the preface — to present an outline not
designed to take the place of standard text-
l)ooks, but to present an inexpensive aitl for
orientation to the subject; to give a general
survey of the field before beginning the course,
and to lay a growing foundation during the
course. The outline is directed specifically to
the medical students, but it should be very use-
ful for medical technology students, pathology
residents, and to those individuals who desire
an inexpensive, up-to-date source of refresher
material in preparation for the examinations.
The only comparable work which this reviewer
knows of is Sawitz's "Medical Parasitology."
TIio subject matter is introduced logically
and the text is written clearly and in a style
that would appeal to a neophyte in this field.
The diagrams are simple and illustrate the

Vol. 49. No. 4

MEDICAL SCHOOL SECTION

important details without confusion. The one
attractive feature that the reviewer lias not
seen before in a book on parasitology is the
presentation of case histories which helps to
coordinate the basic science aspect with the
clinical aspect. It must be recognized that this
text must be used in conjunction with actual
laboratory sessions. (An atlas, such as Spencer
and Alonroe, the color atlas of intestinal para-
sites, Clias. C Thomas, is helpful here.) In
addition, the student should have access to
standard larger textbooks, such as the most
recent edition of Craig and Faust. Another at-
tractive feature of this type of book is tlie
ability to revise frequently and inexpensively,
incorporating recent developments in this field.

Robert Y. Katase, M.D.

Cancer of the Stomach by William H.
ReMine, M.D., James T. Priestly, M.D.,
Joseph Berkson, M.D., and members of the
stafif of the Mayo Clinic. Pp. 255, illus.
W. B. Saunders Co., Philadelphia, Pa.
1964.

This monograph is intended as a reassess-
ment of an old and difficult problem, carcinoma
of the stomach. It contains a plan for manage-
ment based on a large group of cases at the
Mayo Clinic. Its purpose is to decrease the
"discrepancy between incidence and operabil-
ity."

Early detection is the key to improved sur-
vival and great emphasis is placed on methods
of diagnosis. There are separate chapters on
recognition of gastric neoplasms, roentgenology,
gastroscopy, and special procedures, i.e., gastric
analysis, cytology, tetracycline fluorescence, and
autoradiography, as well as blood typing and
electrophoresis of gastric juice. An excellent
chapter is included on indications for operation
and certain key decisions to be made at the
operating table. Surgical technique is covered
in detail with numerous alternative procedures
critically discussed. Postoperative care is well
covered. There is an outstanding di.scussion
of pathology of gastric tumors, as well as an
extensive statistical summary.

The advantages and disadvantages of tiic
book are the same — it expounds in a rather
dogmatic way the philosophy of the Mayo
Clinic group, which gives the text clarity and
continuity in expressing an excellent approach
to the problem. However, other authorities are
largely ignored.

The bibliography is only fair. The index is
complete. Illustrations are of high quality and
complement the text. This monograph is recom-
mended as an excellent source of information
for the general practitioner and internist, as
well as the general surgeon.

Caki. F. Bern?:r, M.D.

Current Therapy 1964 edited by Howard F.
Conn, M.D. Pp. 797. W. B. Saunders Co.,
Philadelphia, Pa. 1964. $13.00.

This is the 16th edition compendium which
includes a wide range of therapeutics. The book
is unique in that it treats each subject briefly
but with reasonable thoroughness. The contrib-
utors are most competent and total 317. There
is no attempt to give different points of view,
l)ut rather each problem is discussed according
to the method of the contributor. This, in my
view, is desirable since it offers to the reader
who seeks information by a quick reference
an opportunity to focus clearly and directly
on a sound method of management. There is
an excellent group of consulting editors. The
material is well indexed, well written, concise,
and most appropriate for the purpose for which
it is intended.

The book is divided into 15 sections includ-
ing, in addition to the major systems, obstetrics
and gynecology, physical and chemical injuries,
the infectious diseases, and the urogenital tract.
There are no lists of references. There is no
attempt to discuss the disease except as it per-
tains to an understanding of therapy. The read-
er must first have made the diagnosis. The
book will be of most use to the internist,
generalist, resident, intern, and medical student.

Edward F. Cotter, M.D.

The Motor Endplate by Sumner I. Zacks,
M.D. Pp. 321, illus. W. B. Saunders Co.,
Philadelphia, Pa. 1964. $17.00.

In 1961 and 1962 Dr. Zacks, together with
Dr. Joe AI. Blumberg and others, published a
series of articles on the motor endplate in
Alyesthenia Gravis as well as some studies of
this structure in animal material. The present
monograph is an expansion of that work. It
includes a review of the history of thought on
the neuromuscular junction as well as chap-
ters on physiology, histochemistry, and pathol-
ogy. The text is illustrated by numerous light
and electron micrographs as well as tables and

October, 1964

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

line drawings, the latter being of particular
value in illustrating the present concepts of
the ultrastructural anatomy. Also included is a
discussion of those areas as yet untouched by
investigative work. The author's own views are
liberally represented throughout, pointing out
areas where doubt exists or further work must
be carried out. A compilation of staining
methods for neuromuscular material is present-
ed in the appendix, and the index is complete
and well chosen. Since this area of human dis-
ease is far from complete, the book cannot be
complete. It is rather a compilation of that
which has already been started and w'ill serve
those interested in neuromuscular disease as a
guide for further study and experimentation.

Howard M. Wisotzkey, M.D.

Aids to Physical Chemistry, 3rd ed. A. J.

Grimes. Pp. 292. The Williams & Wilkins
Co., Baltimore, Md., 1963. $3.75.

This is a small, ready reference concerning
the basic facts of physical chemistry as applied
to medical problems. The main object of the
pocket-sized volume is to provide concise basic
information on physical-chemical phenomena
related to biological activity. The scientific
method, laws of chemical combination, atomic
structure, isotopes, valency, the various states
of matter, their changes, solutions, the rate of
chemical reaction, equilibrium, catalysis, ion-
ization, electro- and thermo-chemistry, absorp-
tion, and chromatography are the chief chapter
headings. The text is simple and non-mathe-
matic. An appendix of important general data
is supplied.

J. A. W.

Physical Examination of the Surgical Pa-
tient by J. Englebert Dunphy, M.D., and
Thomas W. Botsford, M.D., 3rd Ed. Pp.
396. W. B. Saunders Co., Philadelphia, Pa.
1964. $8.50.

This book emphasizes the necessity of a
careful and thorough physical examination in
the evaluation of the surgical patient. The
authors deplore the tendency of modern medi-
cine to de-emphasize this most important facet
of the surgical workup. Technique receives its
proper emphasis, but, at the same time, the
authors discuss certain diseases and their patho-
physiology in relation to physical signs.

Three chapters have been added to the 3rd
edition — examination of heart patients with a

surgical condition and burned patients. A sec-
tion on emergencj' resuscitation is also included.
A chapter deserving special jiraise is devoted to
the examination of the acutely injured patient.

Many photographs have been added and line
drawings redone. All illustrations are of excel-
lent quality and refer directly to the text, which
is lucid and easily readable. The bibliography
is good and the index complete.

This volume serves its stated purpose well.
It should be of great value to students, house
officers, and practitioners of all disciplines,
medical and surgical.

Carl F. Berxer, M.D.

Lysosomes (Ciba Foundation Symposium),
ed. by A. V. S. de Reuck, M.Sc, D.I.C.,
A.R.C.S., and Margaret P. Cameron, M.A.
446 pp. Little Brown and Company, Bos-
ton, Mass. 1963. $11.50.

In 1955 De Duve formulated the interpreta-
tion that many hydrolytic intracellular en-
zymes (e.g. : acid phosphatase, cathepsin, and
ribonuclease among several) were associated
with cytoplasmic particles which he isolated
and called lysosomes. This formulation was
suggested from his work on rat liver homo-
genates. Since that time considerable work,
both biochemical and cytologic, has been done
to establish the fact that several hydrolases
important in cellular metabolism are contained
in cytoplasmic organelles bounded by a lipo-
protein envelope, and that materials ingested
in bulk by the cell are metabolized in part by
the enzymes in these so-called hydrolytic sacs.
Current thinking is that most cells have these
organelles, but especially prominent cell types
containing relatively greater amounts are liver
cells, proximal convoluted tubule cells of the
kidney, and macrophages.

This excellent Ciba symposium held on
Feb. 12 to 14, 1963, permits an assessment of
the present status of the lysosomes as w'ell as
their significance in cell structure and function.

De Duve and Novikoflf open the symposium
by relating how the definition and concept of
lysosomes evolved, dividing the class of organ-
elles into four types: 1) a storage granule, or
primary lysosome ; 2) digestive vacuoles,
which have incorporated environmental sub-
stances of all kinds, and which in some way
receive the catabolic enzymes from the storage
granules; 3) autophagic vacuoles, which form
in the cytoplasm to degrade other organelles.

Vol. 49, No. 4

MEDICAL SCHOOL SECTION

such as mitochondria; and 4) residual bodies,
which contain the materials not easily attacked
by the hydrolases from the storage granule.

Thereafter the contributions of various
authors relate the methodology and animal
models which have been used to uncover the
function of this cytoplasmic body. It is shown
that the organelles are present in protozoa as
well as metazoa. They are important in embry-
ologic differentiation and organism develop-
ment, the latter as illustrated by Weber, who
describes their presence during the sequence
of the tail atrophy of tadpole metamorphosis.
In this latter situation they appear to be
mainly associated with the macrophages which
are in abundance among the degenerating tail
muscle cells.

Another area of involvement is discussed by
Dingle, who relates the part lysosomes appear
to play in the degeneration of cartilage under
the action of vitamin A. This vitamin appears
to reduce the stability of lysosomes, whose en-
zyme contents in turn degrade surrounding
connective tissue.

Cohn, Hirsch, and Wiener discuss the gran-
ules of the polymorphonuclear leukocyte as
being an example of so-called primary lyso-
somes, which apparently discharge their hy-
drolytic contents into the phagocytic vacuoles
developing around ingested material.

In human disease De Duve relates the work
of Hers (p. 22) who hypothesizes that one of
the forms of glycogen storage disease has as
its basis the lack of a lysosomal a-glucosidase,
which is necessary for the breakdown of
glycogen.

As in past Ciba Foundation volumes consid-
erble information and insights are generated
by the interplay of symposium participants in
the general discussions following each paper.

Peter Rasmussen, M.D.

Primary Intramedullary Tumors of the
Spinal Cord and Filum Terminale by

Johan L. Slooff, M.D., James W. Kerno-
han, M.D., and Collin S. MacCorty, M.D.
Pp. 255, illus. W. B. Saunders Co., Phila-
delphia, Pa. 1964. $13.50.

The rarity of primary tumors of the spinal
cord makes it unlikely that any one person will
have a wide experience with them. The publi-
cation of a careful study of a large number of
such neoplasms is, therefore, a noteworthy
event. This monograph represents the collective
experience with 301 of these tumors seen at
the Mayo Clinic. It contains a discussion of
the various histologic types of spinal cord
tumors including both their clinical and patho-
logic characteristics. A series of 42 case reports
is used to illustrate the material. Gross and
microscopic photographs as well as a number
of tables are used to illustrate the te.xt. The
appendix presents the pertinent data on all the
cases in tabular form. The bibliography is com-
prehensive and well chosen. Although the vol-
ume is primarily of interest to the neurologist,
neurosurgeon, and pathologist, any physician
who from time to time must deal with these
tumors will find this a valuable source of
information.

Howard M. Wisotzkev, M.D.

October, 1964

OFFICERS

President |

J. Howard Franz, M.D.
President-Elect

C. Parke Scarborough, M.D.

Vice-Presidents

F. A. HoLDEN. M.D., Baltimore

Robert \V. Farr. M.D.

Chestertovvn, MJ.
John E, Moran. M.D.,

Greenfield, Mass.

Secretary

Tno.MAS B. Connor, M.D.
Treasurer

Walter E. Karfgin, M.D.
Executive Director
William H. Triplett, M.D.
Executive Secretary
Mrs. Wm.. B. Girkin
Board of Directors
Harold P. Biehl, M.D.
Joseph D'Antonio, M.D.
Robert B. Goldstein, M.D.
William H. Kammer, Jr., M.D.
Hugh B. McNally, M.D.
Emmanuel A. Schimunek, M.D.
Rennert M. Smelser, M.D.
William J. Supik, M.D.
John D. Young, Jr., M.D.
George H. Yeager, M.D.

(ex-officio)
Gibson J. Wells, M.D.

(ex-officio)

Nominatinsr Committee

George H. Yeager, M.D.

chairman
Gibson J. Wells, M.D.

(ex-officio)
Raymond M. Cunningham, M.D.
David Levy, M.D»
Donald W. Mintzer, M.D.

Representatives to General
Alumni Council

George H. Yeager, M.D.
Gibson J. Wells, M.D.
William H. Thiplett, M.D.

Representatives to Editorial
Board, Bulletin

Harry M. Robinson, Jr., M.D.
John F. Savage, M.D.
C. Vernon Williamson, M.D.
J. Howard Franz, M.D.
(ex-officio)

Representatives to Advisory
Board

Gibson J. Wells, M.D.
J. Howard Franz, M.D.

ALUMNI ASSOCIATION

SECTION

P r e s i d e n t's Letter

Fellow Medical Ahiiuni:

I recognize and sincerely appreciate the honor and
privilege afforded me as president of the Medical
Alnnini Association. I extend to you all my thanks and
l)ledge you the best of my abilities and energies in service
this year. May I take this opportunity to urge all of
}'ou to take a knowledgeable interest in your Associa-
tion. There are those who have served you well ; in
advancing the areas of concern of your organization
and continuing the effectiveness of the group, in relating
the association to the "changing world" of the School of
Medicine of which we are, and should continue to be,
such an integral part. It will be difficult to follow in
the footsteps of my predecessor, Dr. Gibson J. Wells,
for "Gibbie." as your president and in his other service
capacities on the Board of Directors, has had great
interest and enthusiasm and has worked most diligently.
Our Executive Director, Dr. W^illiam H. Triplett, con-
tinues to oil the complex mechanism and diplomatically
guide the "faltering steps" of each incoming president.
One faces a job of this nature with greater assurance
knowing that "Bill" is about. Our new treasurer. Dr.
Walter Karfgin, has a very big pair of shoes to step
into. We all sincerely appreciate the tremendous expen-
diture of ability and time that our retiring treasurer,
Dr. Howard Mays, made. Finally, although this may be
repetitious, I want to express to Dr. Edward Cotter
the thanks and appreciation of our entire organization
for his tremendous job as general chairman of our first
"Maryland Medical Reunion." It is true that many
other people contributed to the success of the meeting
and I cannot begin to list them all nor would I wish to
overlook anyone, so to all others, from the various par-
ticipating groups, from the Medical Alumni Association,
I say thanks.

I can at this time give you the date of our next
Animal Alumni Meeting. It will be Thursday, June 3rd,

Vol. 49, No. 4

ALUMXI ASSOCIATION SECTION

1965. Won't you, this far ahead, circle your calendar on
that (late and plan to attend. Perhai)s you have been
putting off "going l)ack"- — perhaps this will he a par-
ticular reunion year for your class. Interest in and
loyalty to your school would be reason enougli to be
here — all other reasons are added dividends. See you
then !

The nature of our organization is such that the Board
of Directors must conduct the business affairs as repre-
sentatives for you. Nevertheless, it is your organization
and we wish to serve it to the best interests of all con-
cerned and to the furtherance of the policy that ours is
an outstanding School of Medicine. We welcome your
thoughts — be they commending or criticizing — and
would strive to juirsue a course molded by your inter-
ested help. The editor of our Bulletin. \)v. John A.
Wagner, who serves us so capably and well, would
welcome alumni news from you. We all like to read
squibs about our classmates and friends (and even see
our own name in print). This tends to tie us more
closely, too. Jot down the tidbits of interest and mail
them off to John.

Contrary to the thoughts of the poet, we do have a
chance "to pass this way again." Take advantage of it — -
visit your school this year. Be interested in your Alumni
Association and support its objectives. May this be a
meaningful and effective year for our Association.

Most sincerely,

J. Howard Franz, M.D.
President

October, 1964

Alumiii Day and Annual Meeting June 3, 1965

Classes Of 1915 and 1965 To Be Honored At Annual
Banquet At Lord Baltimore Hotel

The Alumni Association has an-
nounced that the annual alumni reunion
day. scientific sessions and hanquet will
be held on Thursday the 3rd of June,
1965, beginning with scientific sessions
held in the morning, the presentation of
the annual alumni award and gold
key with specific honors being paid
the classes of 1915 and the grad-
uating class of 1965. A special com-
mittee has been nominated by President
John Franz of the Alumni Association
consisting of Doctors Howard Mays and
John O. Sharrett who will be co-chair-
men of the reunion classes. This year the
classes of 1920, 1925, 1930, 1935, 1940,
1945, 1950, 1955 and 1960 will plan their
customary five-year interval reunions.
The alumni co-chairmen, five-year cap-
tains, will shortly be nominated.

A committee headed by Dr. Albert E.
Goldstein and including Doctors William
H. Toulson and Ernest L Cornbrooks
are receiving nominations for the honor
alumnus for 1965. It is expected that a
decision will be reached prior to January
1, 1965, with an early announcement of
the honor recipient to be made in a forth-
coming edition of the Bulletin. For the
first time reunion classes will not be held
for the Baltimore Medical College as the
last fifty-year class was honored in 1964.
Reunion classes will include the College
of Physicians and Surgeons and the
School of Medicine of the University of
Maryland. Members of these classes are
listed

CLASS OF 1915
PHYSICIANS AND SURGEONS

Lee K. Fargo, M.D.

8155 Loch Raven Blvd., Baltimore, Md. 21204

Antonio Fernos-Isern, M.D.

House Office Bldg., Washington, D. C. 20025

Edward E. Fitzpatrick, M.D.

317 36th Ave., N.E., St. Petersburg, Fla. 33704

Luis Felipe Gonzalez, M.D.

Box B, Rio Grande, P. R.

R. Basil Linger, M.D.

321 W. Main St., Clarksburg, W. Va.

Wm. Henry McCallion, M.D.

308 Passaic Ave., Springlake, N. J.

Wm. Raymond McKenzie, M.D.

117 Taplow Rd., Baltimore, Md. 21212

Vernon Litzinger Mahoney, M.D.

614 N. 4th Ave., Tucson, Ariz. 85705

Theodore H. Morrison, M.D. Apt. 704

100 W. Cold Spring Lane, Balto., Md.

Juan J. Nogueras, M.D.

468 Caribe St., Box 1214, San Juan, P.

Costa Enrique L. Purcell, M.D.

12 Vives St., Ponce, P. R.*

Ernest M. G. Rieger, M.D.

656 Orchard Pkwy., Niagara Falls, N. Y.

Harry Lee Rogers, M.D.

6 Upland Rd., Baltimore, Md. 21210

Garrett E. Sprowls, M.D.

Genl. Delivery, Globe, Ariz.*

Elmer B. Staley, M.D.

323 E. 11th Ave., Tarentum, Pa.

Paul Beadle Steele, M.D.

509 Liberty Ave., Pittsburgh, Pa. 15222

Raymond Jerome Stockhammer, M.D.

115 E. 61st St., N. Y., N. Y.

J. M. Thorup, M.D.

4927 N. E. 30th Ave., Portland, Oregon 97211

West
21210

14301

* Last known address.

Deceased

.\dlai E. Cai.laghan, M.D.
John Rice Anderson, M.D.

Vol. 49. No. 4

ALUMNI ASSOCIATION SECTION

Jose S. A. Battistini, M.D.
Wm. Henry Bash, M.D.
Manuel B. Berrios, M.D.
Victor Colon Berrios, M.D.
RoBT. Henry Breslin, M.D.
Jose M. Cobian y Alverez, M.D.
Jos. L. Conarton, M.D.
Prince Cooper, M.D.
LiNNE H. Corson, M.D.
Leona Lemon Cramer, M.D.
Stephen A. DeMartini, M.D.
Thomas K. Galvin, M.D.
Lt. Comm. H. E. Gardner, M.D.
Ernest Fred Gott, M.D.
Wm. O. Hearn, M.D.
Ira C. Hoffman, M.D.
Colin McLean Holmes, M.D.
Andrew J. Jackson, M.D.
Dennis Bliss Jarrell, M.D.
Harry Hayward Johnson, M.D.
F. X. Kearney, M.D.
Thos a. Lamb, M.D.
MiLFORD Levy, M.D.
J. B. LoHAN, ALD.
Curtis L. Lyon, M.D.
Alvin McClung, M.D.
Robert S. Peck, M.D.
Herbert G. Perry, ALD.
GiLBERTO S. Pesquera, M.D.
Millard L. Raemore, M.D.
Oscar Wm. Renz, M.D.
Wm. Cullen Spalding, ALD.
Charles C. Spangler, ALD.
Harrison AL Stewart, ALD.
Boleslaw H. Tadeusick, ALD.
Israel Trachtenberg, ALD.
Fred P. Weltner, ALD.
RuFus Woodall, ALD.

CLASS OF 1915
UNIVERSITY OF MARYLAND

Harvey Clifton Bridgers, ALD.

Blue Ridge Sumniitt, Pa.

Louis Arthur Buie, ALD.

200 First St. S.W., Rochester, Alinn.

Charles A. Cahn, ALD.

2145 W. Baltimore St., Baltimore, Aid. 21223

Thos. AL Calladine, ALD.

1102 Niagara Ave., Niagara Falls, X. Y.*

Ralph Cohen, ALD.

2311 Univ. Blvd., W., Silver Spring. Aid. 20902

Vincent J. Demarco, ALD.

1642 Poplar Ave., Alemphis, Tenn. 38104

Alberto Garcia de Quevedo y AIunoz, ALD.

CCC Hdqtrs., Whipple, Ariz.*

Louis Diener, ALD.

2449 Eutaw PI., Baltimore, Aid. 21217

Joseph Lee Dowling, ALD.

207 Waterman St., Providence, R. I. 02906

AIicHAEL Jos. Egan, Jr., ALD.

210 E. Liberty St., Savannah, Ga. 31401

L. L. GoRDY, ALD.

5106 Harford Rd., Baltimore, Aid. 21214

Samuel H. Greenberg, ALD.

411 W. 7th St., Los Angeles, Calif. 90014*

Gerald Leo Higgins, ALD.

317 Washington St., Avon, N. J.*

Robert B. Hill, ALD. (Brig. Gen. Ret'd)

Southern Pines, N. C.

William H. Jenkins, ALD.

2024 R St. N.W., Washington, D. C, 20009

Wm. R. Johnson, ALD.

Aledical Arts Bldg., Baltimore, Aid. 21201

Roy R. Kerkow, ALD.

505 Yakima St., Wenatchee, Washington

Herman Warner Krantz, ALD.

Address Unknown

Addison LeRoy Lewis. ALD.

214 N. Union Ave., Havre de Grace, Aid. 21078

Oscar Vernon Linhardt, ALD.

710 N. Bradford St., Baltimore, Aid.*

Wm. Cleveland AIiller

7 Brooks Ave., Gaithersburg, Aid. 20760

Danl. Bruce AIoffett, ALD.

1150 Conn. Ave. N.W., Washington, D. C. 20006

Charles Howard AIoses, ALD.

919 Linden Ave., Sharon, Pa.

Chas. W. AIyers, ALD.

R. D. 18, Box 256, Indianapolis, Ind. 46224

AIilfert Weaver AIyers, ALD.

106 E. Alarket St., Warren, Ohio*

Alberto Portuondo y del Pino, ALD.

Address Unknown

AIoses Raskin, ALD.

6221 Greenspring Ave., Baltimore, Aid. 21209

Wm. T. Ruark, M.D.

Pinecrest Sanatorium, Beckley, W. Va. 25801

Playford Lorenza Rush, ALD.

Address Unknown

Lucius C. Sanders, ALD.

20 S. Dudley St., Alemphis, Tenn. 38103

Harry Schnuck, ALD.

1203 San Diegiato St., Encinitas, Calif.

Louis W. Schreiber, ALD.

261 El Camino Dr., Beverly Hills, Calif.*

Frank Earl Shipley, ALD.

Savage, Aid. 20863

Chas. E. Sima, ALD.

2074 E. Belvedere Ave., Baltimore, Aid. 21214

Lt. John Thos. Stringer, ALD.

Naval Hospital, Portsmouth, Va.*

October, 1964

BULLETIN OF THE SCHOOL OF MEDICIXE, UXirERSITY OF MARYLAND

Jos. JuDSOx Wafk, }kI.D.

Box 235, Shenandoah, Va.

EuGEXE Joshua Karl Zeller, M.D.

2739 Eastern Ave., Baltimore, Md. 21224

Mark V. Ziegler, M.D.

Ohiey, Maryland 20832

* Last known address.

Deceased

R. BiNioN, M.D.

JOCELYN BlACKMER, M.D.

W. A. Bridges, M.D.
W. B. Burleson, M.D.
Geo. H. Dorsey, M.D.
P. A. Durkin, M.D.

D. P. Etzler, M.D.
G. A. Fritz, AI.D.
H. J. Gilbert, M.D.
C. Gonzales, M.D.

L. W. Grossman, M.D.
M. E. Jones, M.D.
J. I. Justice, M.D.
B. R. Kelley, M.D.
F. H. Lackey, M.D.
T. B. Warner, M.D.
B. L. Wilson, M.D.

E. W. Lane, M.D.
L. J. Lanich, M.D.
J. A. B. Lowry, M.D.

K. McCULLOUGH, M.D.

A. E. AIcRevnolus, M.D.
L. R. Meyers, ALD.
T. L. Morrow, ALD.
A. A. Nauma.x.x. M.D.
Ray Hickman, M.D.
A. H. RioRDAN, M.D.
J. D. Robinson, M.D.
G. p. Ross, M.D.
S. D. Shannon, M.D.
M. B. Sharkey, M.D.

D. C. Studebaker, M.D.

E. H. TONOLLA, M.D.

J. C. Woodland, M.D.

Dr. Franz, Alumni President,

Appoints Nominating Committee

for 1965

At the regular meeting of the Akimni
Association in 1964, the election of a
Nominating Committee for the ensuing
year did not take place. Accordingly, a
committee has been appointed consisting
of the following physicians :

Dr. George H. Yeager, Chainiian
Dr. Gibson J. Wells, ex-officio
Dr. Raymond M. Cunningham
Dr. David Levy
Dr. Donald ^^^ Mintzer

Vol. 49, No. 4

Class

NOTES

Elsewiierk In this edition you zvill
find a "tear out" page, joy reporting
Alumni Nezvs to the Bulletin. This is
not an idle gesture.

]'our acliiez'einents, fellozv alumnus,
are of i)iterest to your classmates. They
constitute a reheard to the facidty, are a
challenge to the younger physicians, and
are an item oj prestige for the Univer-
sity. Please cooperate zvith us by for-
warding nezvs of yourself or any alumnus
to the Bulletin. Thank you.

Class of 1904

Dr. Howard G. Stevens of New

]\Iilfor(l. Connecticut, has lieen ])resented
a special sixtv-vear honor certificate by
the MecHcal Akimni Association. Dr.
Stevens, who is still in active practice,
was i)resent at the annual altmini day on
May 8. 1964.

Class of 1929

Dr. Jacob H. Conn was re-elected
president of the American Board of Med-
ical Hypnosis. He has also been named
a member of the National Scientific Ad-
visory Council of the International So-
ciety for Comprehensive Medicine. He
also serves as a member of the Editorial
Bo.'ird of its Journal.

Class of 1934

Dr. John N. Snyder has been elected
President of the Baltimore County Med-
ical Association. Dr. Snyder practices at
6348 Erederick Avemie in Catonsville.
Marvland.

Class of 1936

Dr. Harry C. Bowie has announced
his association with Dr. Erederick W.
Plugge in the practice of general surgery
with offices at 926 St. Paul Street, I'.alti-
more.

Class of 1937

Dr. Ephraim T. Lisansky, Associ-
ate Professor of Medicine and Associate
Professor of Clinical Psychiatry, was the
moderator of a panel entitled "The Non-
P.sychiatric Physician in His Office" held
on the occasion of the Maryland Confer-
ence on Community Mental Health, Sep-
teml)er 30, 1964.

Class of 1940

Dr. Walter R. Graham was a recent
visitor to San Juan, Puerto Rico, where
Dr. Graham renewed old acquaintances
with classmates Dr. Guillermo Pico, Pro-
fessor of Ophthalmology, and Dr. Luis
Ciuzman Lopez, Professor of Neuro-
surgery at the IVIedical .School of the
Universitv of Puerto Rico.

Class of 1941

Dr. Joseph C. Sheehan of 208 W est

Street, Annapolis, Maryland, has an-
nounced his disassociation from a former
partnership. Dr. Sheehan specializes in
obstetrics and gynecology.

Class of 1942

Dr. Otto C. Phillips of the Magee-
W'omen's Hospital, Pittsburgh, Pennsyl-
vania, has been named Associate Eellow
of the American College of Obstetricians
and Gynecologists at its annual meeting
held in Miami Beach, May 1964.

Class of 1943

Dr. Harold Dillon of 269 South 19th
Street, Philadelphia. Pennsylvania, re-

Octobcr, 1964

BULLETIX OF THE SCHOOL OF MEDICIXE. I'XU'ERSrrV OF MARYLAXD

centlv completed a trip to India and Pak-
istan as a consultant for the Peace Corps.
Dr. Dillon was recently elected to mem-
bership in American Psychoanalytic
Association.

Class of 1944

Dr. Henry W. D. Holljes has an-
nounced the relocation of his office for
the practice of internal medicine and
diseases of the chest to Suite 201, Med-
ical Arts Building. 101 West Read Street
in Baltimore.

Class of 1945

Dr. Frank J. Ayd, Jr., has received
the Saint X'incent Pallotti Award from
the Pallottine Fathers of the Immaculate
Conception Province for his outstanding
contributions to psychiatry.

Class of 1947

Dr. Donald E. Fisher, Chief Health
Officer of the Carroll County (Maryland)
Health Department, presented a paper
entitled "An Integrated Medical-Com-
munity Approach to Mental Illness" at
the Maryland Conference on Community
Mental Health held in Baltimore on Sep-
tember 30, 1964. Dr. Fisher also partici-
pated in a panel entitled "The Non-
Psychiatric Physician in His Office."

Class of 1951

Dr. David Kipnis, Associate Profes-
sor of Pediatrics at the Washington Uni-
versity School of Medicine, has been
named Director of a Pediatric Unit
established by the University in the St.
Louis Children's Hospital. The unit is
supported by the National Institutes of
Health.

Class of 1955

Dr. Henry Booth Higman, former
Instructor in Neurology at Louisiana
State University School of Medicine, has

been appointed to the staff' of the Depart-
ment of Neurology at Presbyterian-St.
Luke's Hospital, New York.

Author of eleven scientific papers
dealing with the chemistry of conduction
and transmission of nervous impulses.
Dr. Higman is a member of the Amer-
ican Medical Association and American
Academy of Neurology. In addition to
working in the investigative field of neu-
rology. Dr. Fligman will continue his re-
search study of nervous impulses. The
electric eel, nature's most potent gen-
erator of electricity, will be used in this
project.

Dr. Higman, who has received an ap-
pointment as Assistant Professor of Neu-
rology at the L^niversity of Illinois Col-
lege of Medicine, received his B.x\.
degree in 1950 at St. John's College,
Annapolis. He received his M.D. degree
in 1955 from the L^^niversity of Maryland
School of Medicine, served a rotating
internship at the Delaware Hospital,
Wilmington, and a residency in neuro-
chemistry at Columbia University under
the National Institutes of Health. He
received certification from the American
Board of Psychiatry and Neurology, in
neurology in 1963.

Class of 1956

Dr. Richard A. Finegold of 3600
Forbes Avenue, Pittsburgh, Pennsyl-
vania, has been certified by the American
Board of Urology in the specialty of
urology.

Class of 1957

Dr. Frederick W. Plugge has an-
nounced his association in the practice
of general surgery with Dr. Harry C.
Bowie.

Class of 1958

Captain Robert E. Cranley, MC,
USAR, who is a member of the staff of
the Armed Forces Institute of Pathology

Vol. 49, No. 4

ALUMNI ASSOCIATION SECTION

specializing in bone diseases, has been
active as a lecturer, having addressed
the staff of the St. Agnes Hospital in
Baltimore and on other occasions having
spoken on "Tumors of Bone" and on
diseases of interest to an orthopedist.

Class of 1958

Dr. William John Marshall of 315

Aberdeen Avenue, Dayton, Ohio, has
completed a three-year fellowship in car-
diology at the University of Cincinnati
School of Medicine. Dr. Marshall has
been recently appointed to a Geograph-
ical full time position under the American
Medical Research Foundation at the Cox
Memorial Coronary Heart Institute in
Dayton. Dr. Marshall will undertake a
])rogram of clinical research in degenera-
tive heart disease and at the same time
will undertake a limited private practice.

Class of 1960

Dr. Morton E. Smith, who is cur-
rently at the Ophthalmic Branch of the
Armed Forces Institute of Pathologv in

Washington, was the author of a recent
paper (see abstract section) entitled
"Retinal Involvement in Adult Cytome-
galic Inclusion Disease."

Class of 1962

Dr. Melvin D. Kopilnick of 4501
Hawksbury Rd., Pikesville, Md., will
begin a residency in Urology at Sinai
Hospital of Baltimore on July 1, 1964.

Captain David G. Musgjerd, MC,

USAF, has graduated from the U. S.
Air Force School of Aerospace Medi-
cine. Dr. Musgjerd is being assigned to
the 868th Medical Group at Goose Bay
Air Force Base, Labrador.

Class of 1963

Dr. Eugene J. Wolski completed his
rotating internship at the Union Memo-
rial Hospital in June, 1964. Dr. Wolski
then entered military service in the U. S.
Navy as a flight surgeon and is now at
the School of Aviation Medicine in Pen-
sacola, Fla.

October, 1964

Class of 1895

Dr. William Spedden Seymour of

Easton, Maryland, died June 27, 1964,
at the age of 93.

B. M. C. 1896

Dr. Richard H. Morris, 93. of 35

Corey Street, Everett, Massachusetts,
and a practicing physician and surgeon
for more than 60 years, died on July 8,
1964, at the Whidden IMeniorial Hos-
pital.

A native of St. Johns, New Brunswick,
Dr. Morris also attended Loyola Univer-
sity Medical School, beginning practice
in 1896 in Everett, retiring only eight
years ago.

He was one of the founders of the
Whidden Memorial Hospital and served
on its surgical staff as well as the surgical
staffs of the Winthrop Community, Mel-
rose-Wakefield, Lawrence Memorial,
and Maiden Hospitals. He was a fellow
of the American College of Surgeons and
a member of the Massachusetts Medical
Society.

B. M. C. 1898

Dr. Burton W. Fassett, of 123 West
Main Street, Durham, North Carolina,
and one of the oldest living alumni of the
School of Medicine, died on May 19,
1964, at the age of 89.

Class of 1899

Dr. Arthur J. Edwards of 615

Chester Street, Bristol, Tennessee, died
:\lay 4, 1964, at the age of 93.

B. M. C. 1901

Dr. Ralph Gibson Perry, Sr., died
at the Mary Fletcher Hospital in Bur-

lington, Vermont, on Feljruary 12, 1964,
at the age of 87.

Following his graduation from the
li'dtimore Medical College, he entered
l)ractice at Jarvisville, W^est Virginia,
from 1901 to 1911, and from 1911 to
1948 he practiced at Wells River, Ver-
mont. He was Past President of the New
Hampshire Surgical Club and was Past
President of the Grafton, New Plamp-
shire, County Medical Society.

P & S 1907

Dr. Joseph C. Peck of 1209 5th
Street, Moundsville, West Virginia, died
August 25, 1964, at the age of 81.

Class of 1908

Dr. Ernest Verlin Nolt of 709 W.

Park Drive, Columbia City, Indiana,
died on June 2, 1964, at his home where
he had practiced for 54 years. Dr. Nolt
was 80.

P & S 1910

Dr. William Byrd Hunter of 1401
Cadiz Avenue, Coral Gables, Florida,
died May 13, 1964. Dr. Hunter was 80.

Class of 1912

Dr. William Michel of 1015 Poplar
Grove Street, died on June 22, 1964.

Class of 1912

Dr. Russell H. Dean of 445 St.

James Building. Jacksonville, Florida,
"died April 21, 1964. Dr. Dean was 74.

P & S 1912

Dr. Fritz Juette Kimsey of 2700
Harford Avenue, Baltimore, Maryland,
died June 22, 1964.

P & S 1913

Dr. Ralph E. Cloward of 2895 Kala-
kaua Avenue, Honolulu, Hawaii, died
May 7, 1964.

Vol. 49, No. 4

ALUMNI ASSOCIATION SECTION

P & S 1915

Dr. Adiai E. Callaghan of 1015
Boston Building, Salt Lake City, Utah,
died April 9, 1964, at the age of 74.

P & S 1915

Dr. Rufus Woodall of 822 Almeria
Avenue, Coral Gahles, Florida, died
March 6, 1964, at the age of 74.

Class of 1917

Dr. Carl Otto Wolff of 501 1st West
Street, Haynesville, Iowa, died August
14, 1964. Dr. Wolff was 72.

Class of 1919

Cyrus F. Horine died at Union
Memorial Hospital, Baltimore, on
Wednesday, February 26, 1964. Death
was the result of rapidly recurring attacks
of coronary occlusion. Dr. Horine was
66.

Following his graduation from the
School of Medicine, he entered the
practice of surgery and served as resident
surgeon at the University Hospital, later
joining the staff and becoming Associate
Professor of Surgery in the School of
Aledicine.

At the time of his death, he was med-
ical director of the Maryland State
Police and consultant surgeon to the
Maryland State Roads Commission and
the Maryland Training School for Boys.
During World War H, he conducted a
study for the state aimed at minimizing
an imbalance caused by military needs
and the needs of the civilian population.

A competent surgeon, Dr. Horine was
deeply interested in the problems of in-
testinal anastomosis. He also published
studies on intrapericardial tension, pub-
lishing also on the healing of wounds.
His inventive mind resulted in a number

of patents, chiefly relating to the relation
of suture materials and dispensers.

A native of Meyersville, Frederick
County, and a graduate of Western
Maryland College, he also attended St.
Johns College. He was a member of the
Baltimore City Medical Society, the
Medical and Chirurgical Faculty of
Maryland, the American Medical Asso-
ciation, the American Academy of Medi-
cine and Surgery, and the Southern
Medical Association.

Class of 1921

Dr. Louis Lass of 2314 Broad Ave-
nue, Altoona, Pennsylvania, died of heart
disease on May 19, 1964. Dr. Lass had
been in the general practice of medicine
in Altoona, Pennsylvania, for over forty-
two years. He was a member of the staff
of the Altoona (Pennsylvania) Hospital.
Dr. Lass was 67.

Class of 1931

Dr. Michael Krosnoif of Scenery
Hill, Pennsylvania, died recently.

Class of 1928

Dr. S. Zachary Vogel of 87-33 95th
Street, Jamaica, New York, died May
14, 1964, at the age of 60.

Class of 1935

Dr. Miguel A. Alonso, P. O. Box

8216, Fernandez Juncos Station, of San-
turce, Puerto Rico, died of a blood dys-
crasia at his home on July 26, 1964. For
a number of years he was a leading
otolaryngologist in Puerto Rico.

Following his graduation from the
School of Medicine, he served his intern-
ship at the South Baltimore General
Hospital and then entered general prac-
tice in medicine in San Juan in 1936.

October, 1964

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

During ^^'orld War II, he served as
a consultant in anesthesiology through-
out the island. Following the War, he
entered specialty training in otolaryn-
gology at the Barnes Hospital in St.
Louis. He ultimately became a fellow of
the American Academy of Ophthalmol-
ogy and Otolaryngology, the American
Academy of Chest Physicians, and the
American Laryngological, Rhinological
and Otological Society. He was a mem-
ber of the International College of Sur-
geons and the American Medical Asso-
ciation. He was also a founder member
of the Centurion Club of the Deafness
Research Foundation.

Dr. Alonso devoted much of his time
gratuitously to the problems of the deaf.
He was a Clinical Professor of Otolaryn-
gology at the University of Puerto Rico
School of Medicine and, from his great
medical efforts, two generations of
Puerto Rican physicians give testimony
to his Hippocratic ideals.

Dr. Alonso is survived by his wife,
and two physician sons, both graduates
of the Yale Medical School. One, Dr.
Miguel R. Alonso, is serving as a resi-
dent in otolaryngology at Johns Hopkins,
and his brother, William A. Alonso, is
serving his internship at the Hospital of
the University of Pennsylvania.

Class of 1936

Dr. Millard F. Squires died recently
at his home, 507 S. Maryland Avenue,
Richardson Park, Delaware. Dr. Squires
was 58.

A native of Wilmington and a gradu-
ate of the Alexis I. duPont High School,
Dr. Squires attended Washington Col-
lege in Chestertown, Maryland, and
Lycoming College, Williamsport, Penn-
sylvania.

Following his graduation from the
School of Medicine, he served in the
United States Navy from 1942 to 1946.
He then returned to Wilmington, becom-
ing active on the staff of the Delaware
Hospital and the Wilmington General
Hospital. Dr. Squires was also an active
member of the New Castle County Med-
ical Society and the Delaware State Med-
ical Society.

Long interested in youth and in ath-
letics, Dr. Squires had been team physi-
cian for the Conrad High School and the
Richardson Park Junior High School
football team, rarely missing a game and
often being in attendance at practice ses-
sions. His interest in young people had
been lifelong. For a while, he served
as a member on the Conrad High School
Board of Trustees. He was a member of
the Richardson Park Alethodist Church.

Vol. 49, No. 4

PLEASE TEAR OUT

ALUMNI NEWS REPORT

TO THE BULLETIN:

I would like to report the following:

SUGGESTIONS FOR NEWS ITEMS

American Board Certification
Change of Address
Change of Office
Residency Appointment
Research Completed
News of Another Alumnus
Academic Appointment
Interesting Historic Photographs

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Send to

Bulletin — School of Medicine
University of Maryland
31 S. Greene St.
Baltimore 1, Md.

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